Nursing home operators are adopting a healthy mix of technological investment and structured processes, always with a goal of improving quality outcomes and empowering leadership. But, determining where and how much to invest in a given technology can be tricky.
While some operators have invested in tech tools to aid M&A decision making, others are using AI tools to parse hospital data for care transition support as well as overcoming burdens of regulation.
For PACS Group (NYSE: PACS), a heavy investment in tech tools provides real-time visibility into operations and helps leaders make informed M&A decisions.
The PACS’ model is based on turning around facilities, and technology deployment allows for infusing newly acquired facilities with “highly engineered,” repeatable processes – oftentimes the secret sauce to PACS’ success, according to PACS CEO Jason Murray.
“We can repeat those same results. That’s what engineered means, in my mind, that it’s repeatable. What that looks like for us is that we’ve created a plan and we have components of that plan to improve the quality of what we do,” said Murray. “Technology does not yield quality in itself. Technology provides visibility, and I think visibility leads to accountability, and then accountability leads to quality.”
Murray made these comments at last week’s LTC 100 conference in Arizona. He was joined by Mark Cronquist, CEO of Southern HealthCare Management in Florida; Susan Strauss, CEO of New Jersey-based Venza Care; and Robin Underhill, CEO of Texas-based Cantex Continuing Care Network.
Technology checks and balances
Utah-based PACS has been acquiring underperforming facilities and improving them through their repeatable processes, Murray said, with the help of tech investments. PACS operates 325 facilities, with 32,208 beds, across 18 states.
“We’re a relatively young company, and I think that’s been an advantage for us because we’ve been able to invest heavily upfront and through the years in a technology platform that allows us to assimilate new facilities fairly easily,” said Murray.
Technology in particular enables accountability in the system, which in turn drives quality improvements. Coupled with tech investment is investment in leaders, giving them space and resources to empower through autonomy.
“There’s a lot of efficiencies that can be gained in technology, and our sector is one that desperately needs the creativity and efficiency that can come through technology,” said Murray. “We’ve created an AI committee, and they evaluate all kinds of AI-related opportunities. There are some that we’ve adopted, there’s others, many actually, that we’ve waited on.”
PACS uses a structured scoring system using tech tools when deciding on their next acquisition, many times dropping deals that fall outside their ability to improve clinical processes or compliance issues that are fundamentally broken.
If, as an exception, the company were to take on a special focus facility, the decision would need to be backed by deep analysis using technology. In this regard, PACS executives view technology as a major differentiator, and for that reason they plan to continue to invest and explore AI through the dedicated AI committee.
That said, Murray expressed hesitation in adopting technology tools prematurely, especially if there are compliance risks around patient data, he said.
“Just speaking specifically of AI, some of the challenges that we found [included] the ability to protect health information,” said Murray. “That’s obviously very important for us from a compliance standpoint. When we think about new technology, that is one area that we just need to make sure we don’t get out too far ahead of what is out there, because it needs to be compliant with the work we do.”
Balancing centralized processes and local autonomy
Underhill focused on consistency in delivering quality care as well. The Cantex team relies on repeatable standardized processes like structured daily meetings and long-standing care protocols to improve care quality.
But striking a balance between centralized guidance and local autonomy is still a challenge for Cantex’s staff – and often a source of tension. Clear direction from leaders can help localized teams with decision making and outcomes, she said.
“Repeatable consistency is critical for us with regards to quality, and so we rolled out these patient care management systems. We’re focused on making certain every single caregiver knows that, so that we are admitting, onboarding the patient in the exact same way,” said Underhill.
Infection control, looking at falls, even checking weight for a patient is standardized across the board for Cantex properties.
“I know there’s this tension between centralized and decentralized, but the more support we can give our staff, and the more direction that they have, the better informed they are,” said Underhill. “They can make independent decisions. They just need some guidance.”
To overcome the burdens of over-regulation, Cantex uses techtools to give more time back to staff to spend with patients. Software that analyses hospital records during admissions is one of these tools. Cantex is also experimenting with AI-driven documentation to improve accuracy and cut down administrative burdens, along with AI for targeted staffing outreach.
“The more we can understand what’s going on with that hospital record faster, the better we are in terms of being informed about whether that patient belongs in a Cantex facility,” said Underhill. “Lifting up critical information like ICD coding, knowing the primary diagnosis, all those crosswalks help us to optimize the patient experience, and quite frankly, align with the rate.”
Cronquist agreed that technology can help with standardizing processes and improving care quality. It can help with tracking quality metrics and consistent mock surveys. After all, maintaining high standards amid challenges from surveyors, managed care organizations and shifting regulation requires vigilance and visibility into data, he said.
“Even within the state of Florida, there’s a huge amount of variability between the regions. We meet with the regional survey teams once a year or so to talk to them about what we’re doing at our centers and what some of the focus areas are that we have,” said Cronquist. Close monitoring by clinical directors, in addition to communication with regional survey teams, are Southern HealthCare Management’s repeatable ways to maintain high operational standards, he said.
Meanwhile, Strauss highlighted a structured system enabled by tech use within Venza Care as well, especially when cultivating leaders in the company. She split staff into three categories: high performers, those with potential and underperformers. Venza focuses on raising up those with potential while systematically removing underperformers from the ranks.
“I’ve really coached our teams to hold on to those strong individuals, requesting the regionals in every department to give me a score for everybody that reports up to them,” said Strauss. “It’s our responsibility to coach them to meet their potential. But with the C players, we’ve tried everything we can, we’ve coached them, we’ve given them as much support as possible, but they’re not keepers.”
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