A nursing home regulatory model focused on real-time collaboration between state, federal and provider leaders is crucial, considering existing outdated and punitive regulatory practices seen in some states.

In Texas, for example, there’s a disproportionate issuance of immediate jeopardy (IJ) citations and associated financial penalties, which discourage investment in the industry while demoralizing staff, Focused Post Acute Care Partners (FPACP) CEO Lori Strubbe told Skilled Nursing News.

Strubbe recently took over as CEO for Fort Worth, Texas-based Focused Post Acute Care Partners in the new year, and has seen first hand the effects of such punitive measures, serving as COO for the company prior to her promotion.

Texas has led the nation in the number of IJ citations in the last couple years, with many being issued months after an event. IJ issuances increased as much as 75% during that time, she said.

“These delayed state findings result in a disproportionate penalty,” said Strubbe. “In any other industry, our outcomes would be recognized as really strong to the point of extraordinary performance. But instead of celebrating any level of accuracy and commitment, we’re penalized.”

The amount of fines isn’t sustainable, she said. FPACP averaged between $250,000 and $500,000 a year in civil monetary penalties (CMP), only to have that skyrocket to $2.1 million paid last year.

Strubbe discussed such regulatory challenges in the state with SNN, as well as exciting therapy and behavioral health programs in the works for the provider. The FPACP leader also shared what it will take to lead in the sector in the years to come, and why experience outside of the sector will aid in skilled nursing’s evolution.

FPACP operates 25 facilities across Texas.

This interview has been edited for length and clarity.

When prepping Focused for the future, what challenges are top of mind? 

The current regulatory approach in Texas feels less focused on improving [reimbursement] and more focused on shrinking market capacity through punitive enforcement. The immediate jeopardy (IJ) citations are often issued months after an event, retroactively and without full context. Those citations result in hundreds of thousands of dollars in fines levied against providers. We’re experiencing this across the state. We do deliver high quality care, but our enforcement outcomes aren’t reflective of that because they’ve been so punitive.

It’s demoralizing to my teams in the field, and it discourages any investments in the communities that the state, along with us, should be supporting. I’ve been in other sectors. I spent a lot of time in manufacturing, so I do tend to look at things a little differently. We deliver on average, 650,000 days of patient care per year. That’s nearly three quarters of a million days of service. If in that span you get a reportable, that’s 0.0003% of that time.

These delayed state findings result in a disproportionate penalty. In any other industry, our outcomes would be recognized as really strong to the point of extraordinary performance. But instead of celebrating any level of accuracy and commitment, we’re penalized.

The state of Texas in the last couple of years has led the number of IJs across the nation. We didn’t go from being middle of the road to number one because all of a sudden we forgot what we were doing … statistically, something’s going on.

There’s been an increase between 67% and 75% of issuance. How does that even make sense?

In the past, we averaged $250,000 to $500,000 a year in civil monetary penalties (CMPs). Between CMPs and legal expenses last year, we paid $2.1 million last year. When I tell you that it’s not sustainable, it’s not sustainable.

How would you improve regulation in Texas, or for the industry overall?

If the goal truly is to get better outcomes for the resident, then the regulatory process needs to be more about real time collaboration, constructive guidance and transferring current communication.

It should be about lifting providers up, not pushing us down and out. This current approach is not sustainable, and it certainly isn’t aligned with what’s best for the residents that we serve. It’s time to move forward to a true partnership, one of collaboration. Quality of care isn’t built on punishment. It shouldn’t be this punitive. It is truly built on trust, accountability and a shared commitment to do what’s right for these residents. That’s what I would tell the state of Texas.

How has previous experience, including your time as COO, prepared you to helm Focused Post Acute Care Partners?

I came up through the ranks via human resources. Eventually, I did earn my administrator’s license, and I advanced through some operational roles here at Focused, including the COO position.

I’ve held senior level positions across other industries outside of health care, and I would say that experience gives me a unique lens as an operational leader in post acute care. Drawing from a diverse set of industry best practices have helped me develop and refine how to engage with the residents, the families, and certainly our team members.

What exciting initiatives do you have planned for the company?

We’ve taken therapy in-house this year … we just did that last month. Through that, we hope to increase our quality of care with our residents, and also introduce some system-wide restorative programs. We’re also looking at some more functional therapy and honing in on that program. In the past, we really focused on goal-directed therapy. Regardless of the patient outcomes, we really need to be focused on those folks that can go home, and we need to be focused more on the people that stay with us longer.

And then, while we haven’t rolled anything out yet, we’re talking about developing behavioral health programs to not only assist our staff, but obviously to take better care of our residents.

We are introducing some new technologies within our system too. We centralized our human resources function several years ago, and then our talent acquisition. That means we do everything through a system, a software solution. We’ve invested quite a bit of time in another technology for our back office, from a billing perspective and from a reimbursement perspective.

We’re expanding from an education perspective, we’re introducing career ladders for our people and giving them advancement opportunities. We’re certainly planning to recognize and reward them for the things that we want to accomplish.

What kind of personality traits, or background makes for a good leader in the nursing home industry nowadays?

I look for leaders today that have more of an integrative systems thinking approach. They understand data and technology, and they reject the blame game between the regulators and the providers – that doesn’t do anything for us. Good leaders in this industry are going to be bold and they’re going to be collaborative; they’re going to rise above the politics and hopefully get us to mutual respect, shared values and sustainable outcomes. True leadership is going to require inspiration first and then management based on principle and purpose.

I don’t think that’s revolutionary, that’s really good leadership.

Leadership with a systems thinking approach and an eye toward tech is spot on. Anything getting in the way of that right now?

Unfortunately, our regulators are slow to make those tech changes. I think the technology already exists today. Technology available could really move us ahead and move us more quickly in the right direction as an industry. Unfortunately, the regulations, in some circumstances prevent that, and they certainly slow it down.