The Knee Bone, Connected To The Five-Star…

The fine folks at AHCA have a few bones to pick with CMS’ proposed rules on Medicare bundled payments for knee and hip replacements. (Photo by Anatomography, courtesy Wiki Media Commons.)

 

Bill Myers

Good morning, ProviderNation. The fine folks at AHCA have a few thoughts on a federal proposal to bundle Medicare payments for knee and hip replacements. The full text is here, but the gist of it is “Whoa.”

“While AHCA supports the concept of bundled payments generally,” association Senior Vice President Mike Cheek says in a letter to the fine folks at CMS, “we believe it is too early for CMS to propose a mandatory model and too premature to design a model with the hospital as the bundle owner.”

Providers are concerned that they’ll be locked out of the new system, which could have a devastating impact on rehab patients, Cheek says. Part of it is the language of the rulemaking notice itself, which puts all power in the hands of hospitals, and part of it is that CMS is over-reliant on its Five-Star rating system.

If CMS goes ahead with the kind of bundled payment system they’re proposing, Cheek says, “two modifications are critical.”

“First, CMS should explicitly affirm that the model protects beneficiary freedom-of-choice of provider, and CMS should not grant any waivers that allow hospital steering or closed networks,” he says. “Second, while AHCA applauds CMS’ willingness to grant a waiver of the three-day rule for [skilled nursing center] admission, we do not believe it is appropriate to tie the use of the waiver to performance on the Five-Star Rating system.”

‘Model 3 Can Work’

As to the first concern, CMS has only just started to test out roles for post-acute care providers in its so-called Model 3 demonstration. “Early results indicate that Model 3 can work,” Cheek says. “However, additional testing and evaluation are needed. The research, to date, has not provided any conclusive evidence on which types of bundles are successful.”

As written, CMS’ proposed rules would simply hand off the bundles to hospitals, which is no guarantee of better outcomes or better savings, Cheek says.

“We believe that savings should come from efficient delivery of services and care coordination, rather than from merely shifting the site of care,” he writes.

Five-Star Fluctuations

Any chance of waiving Medicare’s three-day hospital stay requirements are of course good news for providers and patients, but Cheek says that CMS is risking care by pegging the three-day waivers to the Five-Star system. In part, this is because the rating system itself—updated monthly—is, by definition, unstable.

Data show that, every month, a three-star skilled nursing center has a 15 percent chance of dropping down to two stars or lower in the next 12 months, Cheek says. (And that’s before anyone considers CMS’, ahem, controversial decision to rebase its rating system.)

“Not only will this level of fluctuation impact beneficiary choice of provider, but it also will make implementation of the program logistically challenging for hospitals as they try to establish a network of exclusive three-star or higher SNFs,” Cheek says.

Under the proposed rules, nearly nine out of 10 skilled nursing centers could be closed to patients in the Monroe, La., area in any given month, Cheek says. In other metro areas, the numbers of potentially closed centers are: more than four-fifths of skilled nursing centers for the Lubbock, Texas, area, three-fifths in the Gainesville, Fla., area, more than half in the Kansas City area, nearly half in the Las Vegas and St. Louis markets, and nearly two-fifths in the Seattle market, Cheek says.

I, For One, Salute Our New Insect Overlords

In other news, mad props to the fine folks at the Florida Health Care Association, who’ve just selected a new batch of overlords.

Topping the list are President Joe Mitchell, of Summit Care in Tallahassee (with a tip o’ the cap to Past President Deborah Franklin of Dover’s Florida Living Options); Senior Vice President John Simmons of Avante at Jacksonville Beach; Secretary Marco Carrasco, of West Gables Health Care Center in Miami; and Treasurer Alex Terentev, of Lake Mary’s Gulf Coast Health Care.

The Twitterweb

And, finally, here’s a pleasant reminder that our next #ProviderChats is coming Monday, Sept. 14. Monday, besides being Rosh Hashanah (and a hearty l’shana tovah to us, everyone), is the start of National Assisted Living Week.

We’ve got a star-studded line-up of experts who’ll be taking consumers’ questions on mind, body, and spirit. Be (virtually) there, or be (actually) square.

Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.

 

 

 

 

Training Pays Off

Stan Szpytek

Good morning, ProviderNation.

It is not uncommon to see negative news coverage when disaster strikes at or near a long term care community. The isolated challenges and opportunities for improvement during an adverse event seem to be the “low hanging fruit” for those looking to criticize the operation of health care facilities that suddenly face a crisis or disaster in the midst of their daily commitment of caring for our nation’s elderly and frail with compassion and dignity.Well, I say it’s time for some positive news.

While this local incident itself was somewhat minor in scope (an electrical fire in a SNF that required complete evacuation of a single facility), I believe the narrative provided by one AHCA state affiliate’s director of quality and regulatory services is worth sharing. The comments are directed to the emergency preparedness bureau chief at the state’s Department of Health Services (DHS) summarizing an event that underscores the true benefits of training and preparing LTC facilities to properly manage emergency situations:

Hello Teresa,

I just wanted to share a great success story with you. Yesterday in the early morning, one of our inner facility nursing homes had smoke filling the building. There are 30- to 50-year-old wiring and circuits there, and one arched in the conduit underground. The fire department deemed the building unsafe, and the facility had to be evacuated. There were 84 residents. This facility has many sister facilities here, and they reached out to them. DHS was notified. They set up their Emergency Operation Center (EOC) and donned their Incident Command System (ICS) vests!!!

Yes, this facility had attended the training (Disaster Planning and Nursing Home Incident Command System- NHICS) and were prepared.

Over 50 people arrived to help, and other facilities brought vans, and all residents were safely evacuated starting at 9:00 am and completed by 11:42 am. All families were notified, and the brand new administrator said he watched with great humility and admiration as everything hummed along. Because all the facilities receiving these residents have the same electronic record systems, transfers and transitions went well. Staff was dispersed to the other facilities to care for their residents and will continue to do so until they can return home. Every resident left with their meds and charts.

The facility may be cleared by the fire department today, and they are bringing in a huge generator to run the building until an electrical wiring issue can be addressed. They expect to be able to return residents by Monday at the latest.

I couldn’t be more proud to see something like this actually happen so successfully. I know this is only one facility, but when we evaluate how well this went, there is hope that we really will be “Disaster Ready” as we already are on our way. This facility has promised to tell their story at our state’s conference in October.

One nurse returning to get her car late yesterday evening told the DON, “This is why I love to working here!!!”

We are committed to continue to have more successes whenever the need arises.

“Disaster Ready” is the name that this state affiliate created to “brand” its disaster planning and emergency management resource program. Through grant funding received from the Hospital Preparedness Program, this state, along with many others, is focusing on preparedness through the development and implementation of comprehensive training programs.

So, after reading this success story, you should ask yourself one simple question: “Is our facility Disaster Ready?”

Stan Szpytek is the president of Fire and Life Safety and is the life safety/disaster planning consultant for the Arizona Health Care Association and California Association of Health Facilities. Szpytek is a former deputy fire chief and fire marshal with more than 35 years of experience in life safety compliance and emergency preparedness. For more information, visit www.EMAllianceusa.com or email Szpytek at Firemarshal10@aol.com.

 

Lockdown! Will Your Team Be Ready On A Moment’s Notice?

Stan Szpytek

Good morning, ProviderNation.

• A shooting at a high school down the street from your health care facility
• A felony stop in front of your assisted living community that leads to a police foot chase on your property
• A bank robbery at the corner that turns into a hostage situation
• A train derailment one-quarter of a mile away, where tank cars are emitting toxic fumes
• A peaceful protest that turns violent at a government building near your community
• A report of a person with a gun in your parking lot

If there is an emergent reason to lock down your facility on a moment’s notice due to some type of peril occurring on or near your property, will your team be ready to meet the challenge?
When it comes to assessing potential threats and perils that can impact a long term care facility or senior care community, you must expand your field of vision to account for incidences that can occur nearby and may not be directly related to your operations.

Establishing an “all hazards” emergency management plan and training all staff on all shifts on proper lockdown procedures is a critical step in helping to ensure the safety of residents, staff, and visitors during an emergency where the facility needs to be secured.

A first step in ensuring a successful outcome when the order is received or given to lock down a facility includes clear command and control through the use of the Nursing Home Incident Command System (NHICS).

Having an “All Hazards” Emergency Operations Plan (EOP) in place that utilizes NHICS will help in the immediate decision-making process that will be required at the time of an unexpected adverse event. It will be imperative for the person in charge, known as the Incident Commander, to recognize the potential security threat (see above examples) and take immediate action to lock down and secure the facility. Hesitating during the initial stages of a rapidly evolving incident may put the facility at risk if it is not secured as quickly as possible.

While it is typical to rely on the facility’s maintenance technician to address day-to-day issues pertaining to the physical plant and infrastructure, an emergency lockdown will require the efforts of all staff on duty at the time of the incident.

A common mistake is assuming the maintenance team is responsible for facility lockdown. Of course, most long term care facilities do not have a maintenance technician on duty around the clock and cannot always rely on their immediate availability. Therefore, it is essential for all staff members to understand the specific procedures required to lock down the facility in an expedited manner when an emergency occurs.

This will involve regular training on lockdown procedures to help ensure that the whole team is aware of the steps needed to secure the facility. Specific issues involving access control systems; delayed-egress locking arrangements; securing windows; and closing window coverings, such as blinds and curtains, to restrict vision in or out of the facility must be comprehensively addressed in written procedures and training protocols. Additionally, practicing facility lockdown with drills and exercises will help ensure an appropriate response during a real-world event.

It should be acknowledged that “lockdown” can mean different things depending on the type of incidence at hand. There are lockdowns to keep unauthorized people out of your building during a crisis or emergency, and there are lockdowns to keep people inside of your building. In the case of a potential hazardous materials incident involving the train derailment a quarter of a mile away from the facility, a “lockdown” may be initiated to prevent building occupants from walking outside into a hazardous environment.

Regardless of the reason, your facility needs to be prepared to initiate a lockdown as quickly as possible when such action is warranted. Training all staff on the physical characteristics of the building and the specific procedures necessary to initiate a lockdown is a critical factor in safeguarding the occupants of your health care or assisted living community during rapidly evolving events that may threaten the safety and security of your residents.

Stan Szpytek is the president of Fire and Life Safety (FLS) and is the life safety/disaster planning consultant for the Arizona Health Care Association and California Association of Health Facilities. He is a former deputy fire chief and fire marshal with more than 35 years of experience in life safety compliance and emergency preparedness. For more information, visit http://www.EMAllianceusa.com or e-mail Szpytek at Firemarshal10@aol.com.

Making A Difference

Ken Lund, president and CEO, Nosilla Relyt

Good afternoon, ProviderNation.

During the past four years, Ken Lund headed up a team that survived a 75 percent reduction in daily Medicare reimbursement and transformed Shea Family, an 80-year-old, regional skilled nursing operator, into a full-continuum, post-acute care powerhouse in demand by local accountable care organizations (ACOs) and managed care organizations (MCOs). This article is the first in a series that will chronicle the experience.

I have a signed and dated poster from the grand opening of the Kennedy Presidential Library in 1979 that reads: “One person can make a difference, and everyone should try.” I look at it, read it, and reflect on its deeper meaning daily.

Politics aside, it seems to me we should all aspire to accomplish simple daily tasks and minor miracles that lead to a quantum shift for the betterment of our society. We can no longer trust in or believe in conventional mechanisms, as they are broken and incapable of rational and logical change or repair.

Believing In A Vision

I have an enormous amount of hope and faith in the spirit that resonates in each of us to do well. We are born with it. Most of us in the long term and post-acute care business start our actions with the intent to “do no harm” and with our personal/individual commitment to do right for our residents, in simple ways, every single day. It doesn’t take government intervention; it takes a commitment to an idea or vision.

The road to health care reform has been fraught with plenty of failures—and plenty of us will continue to crash and burn—but it is in failure that we find learning and strength. If reform were easy, we would have made better decisions about Medicare decades ago, when it was first rolled out … around 1966, during the Johnson administration.

The Choice

For Shea Family, the moment of epiphany came four years ago. Market forces were lining up, and the tipping point had been reached—indicating it was time to take the plunge. The team had a choice to make: Either change fast or watch revenue evaporate.

Few can imagine a 50 to 70 percent cut in skilled rates, but that’s exactly what unfolded in southern California. Today, providers are contractually obliged to demonstrate measurable outcomes in exchange for volume from MCOs and ACO partners.

As a team, we tinkered, experimented, and restructured several times before getting the model right (and to some degree not only are we still at it, we will always be at it). The model we have today has been in operation for the past two years. In future blogs, I will unpack the five innovations that make it work, one by one.

The Results

Today Shea Family is demonstrating performance that is two times more effective and efficient than the norm at a county, state, and national level, as follows:

• 75 percent of patients in Shea Family skilled rehab go home in less than two weeks, compared with 35 percent across California.
• More than 50 percent lower readmission rates compared with peers.
• 75 percent of Shea Family Care Centers are Four- to Five-Star rated, as calculated by the Centers for Medicare & Medicaid Services. This compares with just over 33 percent nationwide.

What Went Into The Model

The new model for care requires a coordinated network with aligned values and a breadth of service lines across the full continuum. We borrowed ideas from other industries as we innovated. Referrals from partners flow in because Shea Family was able to eliminate layers of management overhead that the ACO/MCO would have had to absorb. The model also aligns with acute hospitals and managed care payers.

Changing the way business is done resulted in enhanced outcomes, higher satisfaction from participants, and dramatically reduced expenses to payers. Change is always tough, but for this provider, in this very competitive region, survival depended on it.

So when I look up at JFK’s boat on the water I’d like to think he understood how to read the wind, the water, and adapt strategy accordingly. He’s looking not at the sail, but through the sail—an important lesson about balancing short-term needs with moving an organization forward toward a broader horizon. Success for him required anticipating course corrections and staying in front of changes to come.

I would like to think then, just like today in our changing environment, he knew that failure to anticipate and adapt would likely leave him in very rough waters without the right people, a plan, and the resources to get through it.

Our patients, families, employees, partners, our kids, and our country are counting on each of us to do our part. We must not only read the wind and the water but also look deeply into ourselves … to chart a new course.

Ken Lund is among the nation’s leading experts in reform for post-acute care, having implemented a successful model in San Diego County that quickly captured majority share from the three health systems dominating the region: Kaiser Permanente, Sharp Healthcare (a Pioneer ACO), and Scripps. In addition to his current role at Shea Family, Lund heads Nosilla Relyt, a consulting practice, where he has helped fellow chief executives design, execute, and run a variety of programs, including strategic planning processes, vendor/contractor agreements, purchasing programs, key executive recruiting, benefit plan design, operational start-ups, and management training programs.

 

 

Aloha, National Nursing Home Week

Joe DeMattos

As AHCA/NCAL’s National Nursing Home Week draws to a close, Hawaii-native Joe DeMattos brings us all a little closer to Hawaii with some insights about the word “aloha” and its true meaning.

Good Morning, ProviderNation.

Aloha is among the best-known words in the world. Most people know it as the traditional way to say “hello” and “good-bye” in Hawai’i.

But aloha means so much more. When you say “aloha” to someone, you are saying that love flows between you.

“Aloha au iā ‘oe” means “I love you” in ‘Olelo Hawai’i, the language of Hawai’i.

This year, the theme of National Nursing Home Week is “Living the Spirit of Aloha.” When one lives with the aloha spirit, one lives with, and is, an agent of it. In this sense, aloha is a noun, and it is a powerful verb of action.

To hold the idea, the noun of aloha and all that it means in the thousands of years of proto-Polynesian and Hawai’i history is to believe and value right thought, right action, respect for others, forgiveness, kindness, compassion, empathy, and love. Aloha is the description of the ultimate world-view of abundance.

Putting aloha into action as a verb means acting on its values in how you treat yourself and in how you view and treat others.

“Living the Spirit of Aloha” in health care assumes the best of yourself and of those with whom you interact—family, patients, residents, colleagues, and even opponents.

Interestingly, the “hand shake” of Hawai’i is to look into the eyes of the person you are greeting, to embrace, touch foreheads and noses, and to exchange the breath of life, the spirit of aloha.

Here in Maryland, 233 skilled nursing and rehab centers provide over 9 million days of care each year to Marylanders in need.

Many in care are “kupuna,” our treasured elders; some, increasingly more, are younger.

As we celebrate and create new living examples of the meaning of aloha, we have an opportunity to double our efforts to “Live the Spirit of Aloha” with all in care, young and elder.

Here are seven simple steps to “Live the Spirit of Aloha” every day:

• Love yourself in a positive way.
• See the best in yourself and others.
• Self-right any of your wrongs.
• Seek and offer forgiveness openly and often.
• View and act as your best possible self and view others the same.
• Work as a team—the flowing love always implies relationship—with others and your highest self.
• Make it your mission to help all with whom you interact to be their best self.

Aloha au iā ‘oe.

Born and raised in Hawaii, Joe DeMattos is chief executive officer of the Health Facilities Association of Maryland, which represents most of the state’s 233 skilled nursing and rehabilitation centers. He can be reached at: jdemattos@hfam.org.

What Does Your Resume Really Say About You?

Bernie Reifkind

Good morning, ProviderNation.A resume is the very first impression that one makes to an employer. A resume is a mirror reflection of who you are. Are you serious about yourself? Do you respect your career? Do you want to be perceived as someone who has their act together? Of course you do.

A resume is a very serious document with very serious implications and insinuations. Your resume not only speaks volumes to a prospective employer, it also has powerful implications in not so subtle ways. Now, more than ever, in the very competitive hiring environment of long term care, resumes are being judged by their very appearance. That in itself is a serious implication about how an applicant is perceived.

In the digital age, resumes are glanced at before even being read. How do I know this? I am privy each and every day to business owners, employers, decision makers, and human resource professionals whom I assist in filling their very critical job openings.

They tell me—quite often—why they choose to interview one person over another. And in many cases, it’s about the actual appearance of a resume that will encourage further reading. I understand this because I see hundreds of resumes each month, and it is amazing to me that many people do not take the time and effort to create one that is professional-looking.

For example, if an applicant is a registered nurse, the letters RN should appear right after one’s name. The same with any licensed professional in long term care. Someone with an advanced degree should also add MBA, MS, or PhD after their name. This is a very common mistake—to believe that the reader should assume delineation by what is written on one’s resume.

The implication of a poorly drafted resume is that the applicant is not taking their career as seriously as they should. This, of course, may or may not be true; however, that his how it is perceived. And perceptions are powerful in the hiring business. Sometimes, I will see a resume so poorly written that I, too, will not bother to read any further. Nor would I ever submit such a resume to one of my clients. A great-looking resume means all the difference in the world in today’s competitive work environment.

Consider this: If a resume is not even appealing to look at, further reading is deemed unnecessary. This was the opinion of three of my longtime clients. What this means is that no matter what experience someone has had, the chances of an interview are greatly diminished with a poorly written resume.

A resume reveals and implies much more about a person than many are aware of. This is what poorly written resumes say about their authors:

1. They do not take their careers seriously.
2. They do not take the interview process seriously.
3. They do not take themselves seriously.

Some employers feel insulted when they review a poorly written resume. Why? Having to read one is waste of their time. In addition, who wants to work that hard to read a resume? So it doesn’t matter who someone is or what they have done if their resume is hard to read, written backwards chronologically with employment dates overlapped, contains misspelled words, or is just plain ugly—the result is the same: It will not get very far.

Sometimes I receive resumes without a working phone number on it, only an email address. What if I want so speak with an applicant? An email address is not enough. Always remember to put your phone number on your resume if you expect to be contacted.

Not knowing how to create a great resume is no longer an excuse. There are plenty of articles on the Web that offer guidelines on how to create a good-looking resume.

As for the content of your resume, it is essential for the employer to easily and quickly identify what you have done, where have you been, and what have been your results. What kind of decisions have you made? A resume reflects your decisions. Are you a job hopper? Does your resume have holes in it?

Search the Web to see how others have created their resumes, or make the investment by enlisting a professional resume service to create a resume that highlights accomplishments versus job changes, if that is your case. This small investment in time or money just might pay huge dividends.

In summary, a well-written resume is a must. Your resume is all about who you are and how you feel about yourself. Perception is powerful. If you do not take the time and energy to respect yourself with a professional-looking resume, subtle and sometimes strong—though incorrect—messages are implied about you, whether or not this is fair.

Today’s guest blog is from Bernie Reifkind, CEO and founder of Premier Search, established in 1987, a nationwide talent acquisition firm in Los Angeles. He can be reached at Bernie@psihealth.com or (800) 801-1400.

New Season, New Hazards

Stan Szpytek

Good morning, ProviderNation.

This past winter was certainly an interesting one, to say the least. Winter storm after winter storm has hammered the United States in what seems like the most extreme and deadly winter season in recent memory.

While spring can’t come soon enough, providers need to prepare for yet another seasonal treat– thunderstorms and tornadoes. Not to forget that hurricane season and another round of wildfires started by lightning strikes are on the horizon as well.

Weather preparedness is often addressed within the confines of “severe” events. As global temperatures appear to be on an upward trend, yet extreme cold and blizzard conditions have impacted the country for the past several months, it is difficult to plan for what will come next.

Long term care providers should consider an “all hazards” approach to weather in the same capacity they plan, prepare, respond, and recover to the other types of hazards and perils that can impact their communities. An essential component of planning is the utilization of reliable resources.

Here is a list of links to obtain critical information and concepts that should be reviewed and integrated into your community’s Emergency Operations Plan (EOP):

• Ready.gov: Severe Weather: http://www.ready.gov/severe-weather
• The Weather Channel: Safety and Preparedness: http://www.weather.com/life/safety/
• CDC: Natural Disasters and Severe Weather: http://emergency.cdc.gov/disasters/
• NOAA: Weather-Ready Nation:
• http://www.nws.noaa.gov/com/weatherreadynation/force.html#.UyxkUpuiQWg
• Winter Weather Preparedness:
• http://www.wunderground.com/prepare/winter_weather_preparedness.asp
• C-SPAN Video of an Extreme Weather Preparedness hearing:
• http://www.c-span.org/video/?317771-1/hearing-cost-extreme-weather
• National Severe Weather Preparedness Week:
• http://www.nws.noaa.gov/com/weatherreadynation/severe.html#.UyxtK5uiQWg

Additionally, a web search of similar resources for your individual state should reveal some regionally specific information pertaining to the unique weather perils that can impact your community. For example, here is a link to an outstanding resource from the State of Illinois: Illinois Emergency Management Agency- Severe Weather Preparedness: https://www.state.il.us/iema/disaster/pdf/severeweatherpreparedness.pdf

Long term care providers need to focus on weather-related events of all types, not just the obvious events that customarily occur in your region of the country. Residing in the Phoenix-metro area, it is comforting to know that tornadoes do not typically occur in the Valley of the Sun. Yet, a tornado reportedly touched down in Mesa, Ariz., a few weeks ago, causing damage to a quiet residential neighborhood in the middle of winter.

Go figure. Be ready of all types of severe and extreme weather.

Stan Szpytek is the president of Fire and Life Safety, Inc. (FLS) and is the Life Safety/Disaster Planning Consultant for the Arizona Health Care Association and California Association of Health Facilities (CAHF). Szpytek is a former deputy fire chief and fire marshal with more than 35 years of experience in life safety compliance and emergency preparedness. FLS provides life safety and disaster planning consultative services to healthcare and senior living providers around the nation. For more information, visit www.EMAllianceusa.com or e-mail Szpytek at Firemarshal10@aol.com.

 

 

You Have The Power To Change Health Care

Scott Rifkin, MD

Good morning ProviderNation.

Having been a physician for the past three decades and a long term and post-acute care provider for nearly a dozen years, I believe there really is room for SNFs to take the lead in changing the health care world.

But before I get into why, here’s a little background on me: Twenty-five years ago, I slapped a sign on an office door and opened my medical practice. Having no patients and needing to provide food for my expanding family, I took a part-time job as the medical director of a nursing home. At the time, I wasn’t smart enough to know that seeing the Maryland Secretary of Health walking the hallways was a bad sign. It was a regulatory nightmare.

Fortunately, I was smart enough to follow the lead of a very smart DON, and despite me, the facility got back on a good footing.

Over the next 15 years, I developed a sideline reputation of being the emergency medical director for troubled facilities, and I plied the trade up and down the East Coast. I was once hired by the city government of Nashville as the medical director of their municipally owned nursing home that had been occupied by sidearm-carrying agents of the U.S. Department of Justice as part of a federal CRIPA (Civil Rights of Institutionalized Persons Act) survey.

In 2003, I had the opportunity to buy a sleepy skilled nursing facility on the eastern shore of Maryland for $8.8 million. My bank account was laughable, so I checked under the pillows of my sofa and only found 63 cents and half a sandwich. The owner, a very sweet elderly lady, was kind enough to lend me the money to buy her facility, and I was in business.

Eleven years later, Mid-Atlantic Health Care owns and operates 16 facilities with 3,000 beds. We specialize in buying nonprofit and county-owned buildings, and we pride ourselves on being a clinically driven company with little regulatory trouble, strong ratings, and a focus on cutting edge technology and products. We lead clinically and invest heavily in our centers and in our people.

In the past two years, we have developed our own data-mining software, opened high-acuity units, and were chosen as a “convener-episode initiator” by CMS in its Bundled Payment for Care Initiative (BPCI). Simultaneously, we’ve grown beds and revenue by 40 percent annually for the past four years.

Five years ago, we guessed that being the best partner of the health system would be a positive thing and someday someone would pay us for that. We started a program to reduce hospital usage by our patients by finding innovative ways to keep them healthier. We hired nurse practitioners, opened high-acuity Step Up® units, invested in IT, and developed a data-mining system that tells us, in real time, when our patients are about to become sick.

The end result is that all hospital admissions are down—not just readmissions. For comparison, readmissions in Maryland dropped from 25 percent to 11 percent. In Philadelphia, where we operate 1,700 beds, readmissions dropped from 45 percent to 19 percent and continue to fall.

With our bundled payment program going live last January, we are focused on making sure that our patients stay healthy and out of the hospital. But don’t get me wrong—we have plenty of problems, too.

Having said that, I come from the absolute belief that SNFs are in a unique position to be key players in responding to this new focus at CMS. The hospital systems will have a very tough time trying to implement population-based cost reductions. They are being asked today to reduce readmissions—a concept that is totally foreign to their corporate cultures. They will soon be pushed to reduce admissions—not just readmissions—and to be responsible for the cost of care of their local population at the community level. I will take a look at the Maryland waiver experiment in future posts to illustrate this point.

However, I believe SNFs can help hospitals achieve these goals and share in the savings to the system. The BPCI program is a perfect example. In bundled payments, SNFs can take the lead and become the “convener” and offer a “gain share” payment back to their local health system. We all know that we can reduce readmissions with focus and effort. This ability to reduce readmissions effectively brings leverage to SNFs as well as the ability to create new revenue streams.

Making your SNF the best partner to the health system will result in moving the payer mix needle and improving your financial status. I will discuss all of this, including our successes and failures, in future posts. In addition, I will try to feature other companies that I see that may have experiences helpful to you.

Feel free to tell me what you think. I enjoy a good argument, so if you think I’m clueless, don’t hesitate.

Scott Rifkin, MD, is CEO of Mid-Atlantic Health Care. He can be reached at scottrifkinmd@gmail.com.

 

 

Play Ball…

The Senate will take up the doc fix “patch” today.

Happy Opening Day, ProviderNation.

The Senate is scheduled to take up the “patch” to the doc fix today around 5:30 p.m. Eastern time. You’ve already heard that House leaders pulled a bit of their own Fake Out last week with an argument-free voice vote. The House text merely extends the current law (including therapy cap exceptions) until next year.

Lobbying-American types doubt that the Senate will scuff up the bill, because this thing has been in extra innings since 2003. So look for Lobbying-American types to make a call to the pen. Because they could use a little relief.

Play ball, indeed.

Bill Myers is Provider’s senior editor. E-mail him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.

Minimum Wage Increase: It Makes Sense, And It’s Also The Right Thing To Do

Joe DeMattos

Good morning, ProviderNation.

In recent years, the inadequacy of the $7.25 federal minimum wage has been a painful reality at the kitchen table of too many families across our nation. Today, millions of people of all ages in communities across the country work full-time at minimum wage jobs, often at more than one job.

The Health Facilities Association of Maryland (HFAM) represents Maryland’s largest and oldest provider community of skilled nursing and rehabilitation centers, which employ 24,000 people and care for 19,000 people daily.

On average, HFAM member skilled nursing and rehabilitation centers pay starting hourly wages of $9.27 for housekeeping workers, $9.11 for dietary workers, and $10.53 for certified nurse assistants. These key members of the care team ensure that our state’s most vulnerable population of older adults, rehab patients of all ages, and people with disabilities are provided with efficient and high-quality care on a daily basis.

The starting HFAM member wage, excluding higher wage earners in administration, is $9.64 per hour, and the average HFAM member wage with the same exclusion is $12.56 per hour. If HFAM were a state, measured by either starting or average wage, it would pay the highest minimum wage in the country.

Even today, about 70 cents on every dollar paid for care in our centers is used to pay wages.

That is why the board and leaders of HFAM voted to support a reasonable and sustainable increase in the minimum wage here in Maryland. It is simply the right thing to do. Recently, President Obama announced an Executive Order requiring federal contractors to pay at least a minimum wage of $10.10 per hour starting in 2015, and funding those contracts to support such a wage. Just as living wages are supported in the funding of federal contracts, so, too, must state and federal reimbursement rates be incrementally increased to support phased-in increases of Maryland’s minimum wage.

Like many states across the country, here in Maryland skilled nursing and rehabilitation centers are a powerful economic engine, with over $5 billion of annual economic impact, producing more than $100 million a year in various taxes. A phased-in, reasonable, and sustainable increase in the minimum wage in Maryland, supported by appropriately funded federal and state rates for care, will ensure access to quality care, set the stage for better care integration between hospitals and skilled nursing centers supported by appropriate staffing, and, most importantly, will create new jobs that are attractive to top talent.

The danger of an abrupt minimum wage increase without the support of adequate funding can have a detrimental effect on employers like HFAM members who already pay wages much higher than the minimum wage. Higher wages without sufficient support in the rate put quality care and job growth at risk.

There are some who eye an increase in the minimum wage with a view of scarcity: There is not enough to go around. And there are some who view it from abundance: Investing in people now will lift all boats. How much of an increase? When? We leave that to the smarter folks. We simply choose abundance: The time is now for a reasonable and sustainable increase in the minimum wage here in Maryland coupled with an investment in quality care.

Joe DeMattos is president of the Health Facilities Association of Maryland, which represents most of the state’s 233 skilled nursing and rehabilitation centers. He can be reached at: jdemattos@hfam.org.