CaringForward

Are SNF Administrators Quitting Because They Don't Want to Sell Cars?

Over at Advance for Long-Term Care, long-time administrator and educator Dr. Brian Garavaglia blames two villains for administrator turnover at skilled nursing facilities:

• Onerous government regulation 
• Clueless corporate ownership

I certainly agree with him about the first villain, but not so much about the second one.

It's easy to see where heavy-handed government intrusion frustrates administrators. Federal rules and regulations, often interpreted and implemented subjectively by the states, consume, confuse and punish nursing home administrators and staff. Garavaglia focuses on the flaws of the nursing home survey process, which is all about handing out demerits instead of collaborating to improve quality of care. Add to that the maligned five-star rating system, that has mostly caused administrators undue confusion and anxiety, all without accurately assessing quality of care. And we visited a nursing home last week that was scheduling weekly MDS 3.0 training sessions from now through October to prepare for the changes, with RUG-IV looming as well. All time spent pushing paper and crossing T's, instead of focusing on patient care.    

And I agree with some of what he says about how corporate ownership and acquisition of skilled nursing facilities can frustrate administrators. As happens in any industry, sometimes investors acquire companies whose business they don't really understand, and unsuccessfully apply financial and profit models that simply don't work. That's just called poor management, and it's not unique to nursing homes or long-term care.

But Dr. Garavaglia broadly asserts that every mulit-location SNF company is run by bean counters who don't understand and disregard what administrators must do to maintain quality clinical care. They bring in clueless "marketers" (the horror!) who "[attempt] to address census and to 'close sales,' similar to those who work in sales and marketing close deals in car sales."

We just don't see that with our SNF clients. I have yet to encounter a CEO, COO or VP of marketing for a SNF chain who views beds as a commodity like cars. (That doesn't mean they're not out there, they just aren't the type who seek our help in building census through automation and reporting.) In fact, many of these SNF companies target poorly performing nursing homes for acquisition, intent to turn around financial health by improving clinical care, quality of life and community reputation. 

You can't keep your beds full if you can't provide quality care, and you can't provide quality care if you can't pay for the people and resources to do so. The best, most successful and ultimately profitable multi-location SNF companies place urgent emphasis on both—and should be able to retain their superstar administrators by doing so.

CMS Hosting RUG-IV Audio Conference Today at 1:30 EST

It has a typically bureaucratic-sounding title: "Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group – Version 4 (Rug-IV) National Provider Call with Question and Answer Sessions"

You can register here. 

You can view and download the presentation in advance here.

Looks like there's a similar session scheduled Sept. 1.

The Need For Speed: Dramatically Improving Referral Response Times

"We need to respond to patient referrals faster." We hear it from every skilled nursing facility client we work with. Faster response times improve admissions and conversion rates and forge stronger relationships with referral sources. Based on the successful experiences of our SNF clients (one of which cut average response times from 30 to 8 minutes), we recommend a few key steps as a starting point: 

• Set specific targets for response times
• Track and measure response times
• Automate and accelerate as many marketing, referral and admissions steps as possible
• Empower liaisons in the field to act quickly and decisively 

Sounds simple, but it's easier said than done, and without the right tools, it's almost impossible. Contact us if you'd like to learn more about how to accelerate response times and admissions with a comprehensive online marketing, referral tracking and reporting systems for SNFs:

• Concurrently view referral records and documents and accept/decline online, documenting decisions at every stage
• Automatically receive alerts such as "New Referral Docs Received" to e-mail or mobile devices to ensure staff is on top of every referral
• Report referral response velocity, with timestamps for each action taken during the review and processing of a patient referral
• Verify insurance coverage instantly through the system and save the results as part of the referral record
• Fax server and dedicated admissions lines convert referral faxes into electronic documents for easy viewing and storage, and no more fax waits
• Post standard admissions forms for easy access and completion, with patient and referral data automatically populated.
• Upload eReferrals from other systems in a single step by printing them into the Referral Management System

Does your SNF marketing budget account for business intelligence?

Patty Cisco recently posted some great considerations for nursing homes preparing their 2011 marketing budgets. Among her recommended marketing budget priorities:

• Brand positioning
• Assessment of marketing effectiveness
• Social media
• Web-site

We agree that these are important priorities for SNFs seeking to build and maintain census in 2011, particularly assessing marketing effectiveness. In fact, we recommend that clients specifically budget for tools that provide reporting and business intelligence related to marketing and census building programs.

We hear from skilled nursing facilities all the time about challenges in capturing fundamental performance information such as conversion and admissions rates, referral source trends, payer mix, liaison activity and performance, and marketing program effectiveness. Without this critical information, the marketing budget process for SNFs becomes a bit of a guessing game.

Consider this example: One large SNF chain client began using our Referral Management System to manage, track and report marketing and admissions activities back in January. Using referral source trend reports from the system, this provider realized that it was receiving a large number of referrals, with a high percentage of Medicare patients, from a city in which it does not even have any facilities. That prompted this provider to dedicate a marketing resource to build relationships with the hospitals and physicians in that city. Now it is receiving nearly twice as many referrals from that region, a market opportunity it would never have recognized without that business intelligence. That’s the type of knowledge that drives truly effective budgeting and allocation of programs and resources. You can’t manage—or budget for—what you can’t measure.

Reimbursement Roundup: Updates on RUGs-IV and Medicare funding

There has been much recent activity and commentary related to RUGs-IV and Medicare/Medicaid funding:

• House removes repeal of one-year RUGs-IV delay in jobs bill

• CMS sets nursing facility payment rate increase at 1.7 percent

• Congress drags feet on Medicaid funding

• CMS releases SNF PPS rates for 2011. Download the complete notice here. CMS has extended the comment date to September 20, 2010.

What SNF Providers are Asking About Marketing and Census Building at LTC LINK

We're excited about kicking off LTC Link 2010 event this July 18-20 at the Hyatt Regency in Chicago, Patient Placement Systems. (Again, kudos to the LTC LINK folks for organizing what looks to be an outstanding event.)

As we've been preparing for our meetings with executives from several nursing home chains, we are hearing some common challenges and concerns related to marketing and census building:

• Census building is our number one operational challenge.
• How can we respond faster to referral sources?
• We struggle to collect and report marketing and census performance information across our facilities, such as referral source trends, conversion rates, win-loss, payer mix, reasons for loss and decline, liaison performance and marketing program effectiveness.
• We're looking for ways to better track and improve patient/payer/reimbursement mix.
• We're developing strategies to offset diminished reimbursements from RUGs IV.
• How can we enable liaisons to make faster decisions and initiate the referral process faster in the field?

These are all great questions and challenges for SNFs, and we're eager to consult with long-term care execs at the event to discuss options and answers for improved census and marketing. We'll be posting ideas and strategies from our discussions.

Link: 10 Things Social Media Can Do For Senior Living and LTC

Brian Geyser at Carenetworks Blog posted 10 things social media can do for long-term care. (It's from a couple of months back, but well worth reposting.) 

I've followed a few of Brian's posts and really like his approach. He doesn't make social media out to be some magic marketing potion that will transform your skilled nursing facilities into Web 2.0 Marketing Sensations overnight. He does provide clear, practical ideas and recommendations that SNFs can start applying today to help communicate and market more effectively to the communities they serve. 

Why You Might Not Know Enough to Establish Your SNF Marketing Budget

In this terrific LinkedIn Long Term Care group discussion about SNF marketing and census building, I came across a great SNF marketing calculator from healthcare consultant Burke & Associates. (From this page, click the "Marketing Goal Calculator" link.)

This calculator is splendidly simple and elegant. Determine what your census looks like today, what you want it to be, and how many additional patients it takes to get there. Based on your conversion and admissions rates, you'll have a clear understand of what marketing investment your skilled nursing facilities require to achieve census and revenue objectives.

Ah, but those conversion and admissions rates. The calculator lets you plug them in, but our experience says many SNF operators either don't know these metrics, or don't trust the figures being reported because of inconsistent and unreliable manual methods for tracking these metrics.

In our eBook about SNF marketing and revenue formulas, our second step to census and admissions excellence is "Start at the end—establish your reporting requirements." We recommend that SNFs identify critical metrics and information—referral sources, conversion and admissions rates, win-loss, marketing efficacy—and adopt systems that automate reporting of those metrics. It's the foundation for smart SNF marketing planning and budgeting. If you can't measure and report these baseline census and admissions performance metrics, it's time to re-evaluate your tools and processes.

Care doesn't end--and marketing begins--when your patients leave your SNF

Patty Cisco at Cisco & Co posts an interesting article about how important it is to make the experience for patients positive when you're discharging them from your facility. As she aptly points out, "these discharged patients can be your best or worst marketers . . . When the patient/family walks away from your service today, how would they describe the last few hours they were with you?” She shares 6 steps to "surprise and delight" patients during and after the discharge process. 

Why haven't you bought your SNF liaisons laptops yet?

I happened across this lively discussion on LinkedIn, with all sorts of industry experts much smarter than me sharing ideas for improving SNF marketing and building census. (Great to see this active discourse in long-term care groups online.) 

One other thing many people in the thread advise is to empower liaisons to make fast acceptance decisions about patients in the field. I offered one extension to that advice: Buy them laptops or netbooks or some other suitable Web-enabled devices. Now.  

Netbooks in particular are so cheap now it seems impossible to afford not to equip the liaisons with them. Dell and others have powerful netbooks that weigh less than three pounds for less than $300 now. Most also have cheap mobile broadband options available from multiple carriers, so they can be Web-connected wherever they are. A single extra patient day could cover the cost of that investment. 

We've seen the results with our SNF clients. Clearly, it makes our Web-based system for automating and tracking marketing activities, and accelerating the referral-to-admissions process, even more powerful. Liaisons are able to make assessments, verify coverage, accept patients in the field, and trigger alerts to admissions staff to follow through immediately. The improved responsiveness and turnaround times are dramatic. It can mean the difference between admitting a well qualified patient, or losing that patient to another facility. 

Even for our clients who don't give liaisons full authority to accept a patient in the field benefit tremendously by giving their marketers Web devices. Enabling them to enter the referral information/documentation online at the hospital, and triggering the assessment and approval process at the facility, has a huge positive effect on admissions rates and patient mix. 

We've heard to argument many times from SNF executives that it's just too costly to equip all of their liaisons with laptops. If their effectiveness makes or breaks your census goals, you might rethink your perspective on that investment. Netbooks for everyone!