CaringForward

Royal Health Group Increase SNF Referrals 19.6% with the Referral Management System

Yesterday we posted an update on Greystone Healthcare Management's big gains in Medicare census through improved marketing, referral management and admissions processes, enabled by the Web-based Referral Management System.

Today we look at Royal Health Group, a six-SNF provider in Massachusetts that also has documented significant improvements in operations and census performance since partnering with PPS to use the Referral Management System. Royal Health group previously documented how automation and live census trend and analysis reports have improve conversion rates, dropped response times by 80 percent, and driven overall revenue growth.

Royal Health Group recently provided some interesting new data: It's overall number of referrals handled has increased by 19.6 percent since it started using the RMS system at all six facilities in summer of 2010. In an increasingly competitive market, in which many SNFs report diminished referrals, a nearly 20 percent growth in less than two years marks a performance milestone.

Royal Health Group attributes the increase to the efficiency realized with the Web-based RMS solution, which enables the six facilities to handle more referrals and strengthen relationships with hospital referral sources. Those stronger referral source relationships make a huge difference, as Royal Health Group noted previously: “Case managers know they will get a decision and place patients faster.”

This quote from the original Royal Health Group success story, from Chief of Business Development James Mamary Jr., sums it up nicely:

“The system gives us unprecedented power to respond faster, outcompete other facilities and report trends and analysis we simply couldn’t capture before. The benefits have exceeded our expectations. We anticipate significant revenue growth through increased referral volumes and conversion rates, as well as a stronger reimbursement mix. That’s money we invest right back into our people and facilities to ensure exceptional care and quality of life for our residents.”

 

 

 

Friday SNF and LTC Roundup: 11.1% Cuts Shift Therapy Considerations, Thoughts on Medicare Fraud, Merger Mania in LTC, and more

• New allocations of group therapy for skilled nursing facilities has shifted therapy almost completely to individual therapy provision in 2012
• Some thoughts about considering rehab/therapy to return patients to previous levels of function when assessing Medicare Part A length of stay: "It is clinically appropriate to continue the therapy program and further progress the patient to his or her highest functional ability."
• Reginald Hislop from Reg's Blog uses big words, and lots of them, and his posts deliver thoughtful, comprehensive, expert analysis about issues that affect your SNFs. These two recent posts examine why complex, convoluted Medicare rules make billing and patient care "fraud" an unavoidable, inevitable reality for skilled nursing facilities.
• The consolidation binge rolls on: Mergers and acquisitions up 39 percent in 2011.

 

PPS Presenting LTC Marketing and Census Strategies at MHCA Symposium June 7-9

We are pleased and honored that the folks from the Maine Health Care Assocition invited us to present a session at the MHCA Leadership Symposium in Northport, Maine, June 7-9, 2011.

Karen Michaud, MHCA's director of education, says the focus of this year's symposium is all about marketing, census building and embracing innovation: “The 2011 symposium focuses on helping providers recognize and develop new strategies for marketing their facilities.” 

Session topics concentrate on three key areas for skilled nursing and other long-term care providers:

• Cultivating a commitment to quality service and care
• Streamlining processes for admissions and referral management and utilizing technology to improve service, such as automated referral systems, electronic medical records and health information technology
• Developing a strong marketing plan, nurturing community relationships, increasing referrals, and improving relationships and responsiveness

 

Our session, scheduled for Wednesday June 8, should sound familiar for past visitors to CaringForward.com. “Coming To Your Census: 8 Steps to Excellence in LTC Census and Marketing Performance,” will present new rules and technology tools to help long-term care and post-acute care providers market more effectively, accelerate referral response times, strengthen referral relationships, and improve case mix and reimbursements. The session covers eight proven steps to excellence in marketing and admissions for long-term care, along with trends in new technologies that are helping top performers work faster and smarter. The session also discusses several real-world examples of providers that are applying these steps, along with automated Web-based marketing and referral management systems, with dramatic performance results.

Other sessions scheduled for the MHCA Leadership Symposium include:

 

• “Reaching Maximum Effectiveness with Functional Marketing Plans,” presented by Patty Cisco, founder of CISCO & CO.
• “Social Media in the Workplace: Developing a Social Media Policy for Your Employees” presented by Melissa O'Dea, attorney at O’Dea Woodman, P.C.
• “Defining the Business Case for Health Information Technology (HIT) in the Long Term Care Sector,” presented by Jim Leonard, director, Maine Office of the State Coordinator for Health Information Technology.

Coverage Roundup of New ACO Rule: What Does it All Mean for SNFs and Long-Term Care?

As you probably know, CMS issued the initial rule for establishing accountable care organizations (ACOs), and it's a whopper at 429 pages. CMS issued the rule (“Medicare Shared Savings Program: Accountable Care Organizations”) on March 31, and opened a 60-day comment period. Here's a look at some of the subsequent analysis and commentary—and there's plenty of it:

• From The Health Care Blog, Vince Kuraitis shares eight first impressions about the ACO rule, notably that the requirements for hospitals to establish an ACO are serious: "The infrastructure, operational and reporting requirements for setting up an ACO have teeth." No dipping your toes in the water here.
• LeadingAge (formerly AAHSA) has published a whitepaper about how nursing homes, SNFs and other LTC and post-acute providers can participate in ACOs. It also has created a tool to assess providers' readiness to participate in an accountable care organization.
• HealthLeaders Media reports on mixed responses to the initial ACO rule. 
• AHCA weighs in with a pretty ho-hum statement about how ACOs can include nursing homes and other post-acute care providers.
• Again from HealthLeaders: Are the savings from participating in an ACO worth the costs? (Or as my boss is fond of asking, "Is the juice worth the squeeze?")
• We hope CMS will uphold this admirable promise to genuinely consider feedback during the 60-day comment period.
• Privacy, fraud and antitrust implications of the new ACO rule. More important things for SNFs, nursing homes and other post-acute and LTC providers to consider.

What Should Your SNFs Target for Medicare Patient Length of Stay?

We've heard from many prospects and industry experts about skilled nursing facilities increasingly seeking shorter stay, high-therapy Medicare patients (see step one in this Long-Term Living Magazine article we previously linked to). One client has told us they are successfully (and dramatically) increasing the number of Medicare or Medicare HMO admissions, while seeing the average length of stay for those patients dip to the sub-20-day range. (How, you might ask? By using our Web-based Referral Management System to automate and accelerate admissions and referral management, and report and understand key referral source and payer trends. End commercial.)

However, we recently heard from another client that bucks this emerging trend toward higher acuity Medicare patients. In reviewing length of stay data, this multi-location SNF COO was encouraged by seeing consistently longer average stays for Medicare, within the 100-day window. Why? He said, with their case mix, his SNFs were being reimbursed at higher rates under the new rules. They realize greater returns, with less cost and effort in new patient acquisition, by managing a longer-term Medicare case mix.

So, I'm curious to hear: What's the average Medicare length of stay at your nursing homes/SNFs today, and what would you like it to be? What are the strategies and trends at your SNFs to best manage quality census and Medicare reimbursements? Have they changed? Are you expanding your rehab and therapy services at your skilled nursing facilities, and does demand for those services continue to grow?

Coming to Your Census: Step 3 of 8—Don’t sweep diminished Medicare reimbursement revenue under the RUGs

Here is excerpt number three from our new free eBook, "Coming to Your Census: 8 Steps to Excellence in SNF Census and Marketing Performance." Step three looks at considerations for RUG-IV reimbursements. 

RUG-IV and MDS 3.0 implementation fuels anxiety about how the changes stand to diminish reimbursement revenue for skilled nursing facilities. We heard recently from the VP of marketing and business development at a nine-location SNF chain that changes in RUG-IV would cost the company $2.5 million in revenue in Q4 of 2010 alone. In particular, he cited revisions to the look-back rules and more restrictive interpretations of other RUG categories as reasons for the dramatic revenue losses.

He calculated the annual loss per bed at $14,000. Do the math for your nursing homes, and it's quickly clear the potential for top-line losses are significant.

What steps are you taking to prepare for the financial hit your SNFs stand to absorb now that RUG-IV has arrived?

We’ve worked with clients to apply better referral management processes and business intelligence to dramatically improve case mix and reimbursements. Greystone Healthcare Management, a 26-facility provider, has documented that 71 percent of new referral admissions in a key region are now Medicare or Medicare HMO, and that the overall Medicare mix is up 23 percent after six months of using the automated Web-based Referral Management System.

The Royal Health Group, a seven-facility provider in Massachusetts, used reporting from the system to improve RUG-IV reimbursement strategies. By reporting reasons for declined referrals, Royal Health Group has identified high-demand clinical services that its facilities did not offer. Many such services align with favorable reimbursements under RUG-IV rules. Royal Health Group now offers or plans to offer specialized, niche clinical services that will increase overall admissions and offset declines in other RUG-IV reimbursements.

Click this link to download the complete eBook for free.

OIG Misses Mark with Claim that SNFs are Cheating on Medicare Billing

So, CMS makes the Medicare reimbursement rules. SNFs follow the rules. Health and Human Services publishes a special thank you: "SNFs, you're cheating."

It's tough business running a SNF. Medicaid underpays. (Really, really underpays—by $5.6 billion in 2010.) CMS establishes dizzyingly complex clinical assessments and categories for Medicare reimbursement (66 utilization groups in RUG-IV), and changes them periodically just to keep nursing homes on their toes.

Skilled nursing facility operators scramble, and rescramble, to keep up, and to apply and manage clinical and reimbursement programs to appropriately bill for reimbursements. They continuously invest in resources to provide services that meet the increasingly complex clinical needs of post-acute patients. They work diligently make their communities, hospital case managers and referring physicians aware of these entened services, from rehab/therapy to vent beds to dementia care and more.

So the HHS Office of Inspector General publishes a 37-page research report claiming SNFs are cheating on Medicare billing.

OK, it doesn't use the word "cheating," but the title "Questionable Billing By Skilled Nursing Facilities" doesn't leave much room for interpretation.

Before analyzing the results, let me say that OIG delivered a comprehensive, well-designed research report. The methodology and analysis are meticulous and exhaustive—with data from more than 12,000 skilled nursing facilities, controls for patient age and diagnosis, clinical breakdowns based on therapy levels and activities of daily living (ADL), and perspectives based on facility ownership (chain or independent).

But the quality methodology produces some spurious conclusions. There's a lot of detail and data, so I'll summarize: Between 2006 and 2008, nursing homes increased Medicare billings for ultra high therapy and high ADL requirements. SNF chains and for-profits billed at even higher levels in those categories. Therefore, OIG concludes that SNFs are possibly (probably?) "gaming" the system by performing or billing for unnecessary clinical/therapy services for patients.

That conclusion ignores many factors. Post-acute care has and continues to become more medically complex. Facilities work hard to add therapy, clinical and care services that patients need and hospitals request, at no small expense. It follows that billings and reimbursements in those categories would increase.

And citing increases in specialized care and high-reimbursement billings from SNF chains and for-profits paints an incomplete picture. Perhaps those larger chains have been able to invest more in providing extended therapy and care services. Maybe they have been more aggressive in pursuing billings in reimbursement groups that pay higher rates. Or perhaps not, but the study unfairly excludes these possibilities from its analysis.

It just seems frustrating for HHS/OIG to take such an accusatory tone in the report—especially given that the research methodology and data are so good. This would have been a great opportunity to share the data with the skilled nursing community for collaborative analysis and discussion about trends in care and reimbursement. Instead, it's yet another example of regulators acting with good intentions, but needlessly punishing SNFs instead of working with them on the common goal of quality care.

Coming to Your Census: Step 2 of 8—Start at the end and establish census and marketing reporting requirements

As promised, excerpt number two from our new eBook, "Coming to Your Census: 8 Steps to Excellence in SNF Census and Marketing Performance."

Most multi-location skilled nursing providers face challenges collecting timely information from facilities about win/loss, conversion rates, hospital and physician referral source analysis, marketer/liaison effectiveness, payor mix, reasons for losses, and more. Executive managers need this information to keep facilities accountable for performance, and to adapt and improve marketing strategies and admissions processes to meet census objectives.

So we encourage providers to start the process by thinking about outputs—what reports, information and analysis are critical to understanding and continuously improving operations and performance. Most often we encounter providers that scramble and struggle to collect this information from individual facilities, frequently in manually compiled reports and spreadsheets of dubious completeness and accuracy. Providers that understand what business intelligence they need can make the most informed, intelligent decisions about the best solutions for marketing and admissions management.

Click here to see some examples of census and marketing performance reports.

 
 

2010 Skilled Nursing Retrospective from McKnight's

The always charming Liza Berger from McKnight's posted this terrific look back at the big events in skilled nursing in 2010.

Among her top 10:

9. Dennis Bozzi being accused of embezzling $670,000 from the Life Services Network of Illinois

5. Controversy about strict (and in some cases punitive or even clinically tragic) DEA regulation of prescription pain medications at nursing homes

No. 2 and 1, no surprises here, are the start of MDS 3.0, and the fits and starts for RUG-IV (with the repeal of the delay coming down to the wire in December).

Certainly, implementation of MDS 3.0 and RUG-IV have dominated the time and resources of our clients and prospects over the last half of 2010.

Coming to Your Census: Step 1 of 8 for Building Census and Marketing Smarter at Skilled Nursing Facilities

We recently published the eBook "Coming to Your Census: 8 Steps to Excellence in SNF Census and Marketing Performance." We will post all all eight steps here over the next few weeks. Here's the first excerpt:

We have helped numerous skilled care providers assess and improve their marketing and admissions management—and ultimately boost census performance and competitiveness. Based on this experience, we have identified eight key steps for skilled nursing facility operators to successfully market and manage admissions better and smarter.

The first step seems intuitive: Acknowledge marketing, sales and admissions as critical operational processes. But that’s not always the case. Even though efficient, responsive marketing and admissions are the foundation for meeting census and performance objectives, long-term care providers often overlook admissions as they focus on other clinical and financial systems. The bottom line: If your facilities aren’t outselling their competitors, your organization will fall short of its financial goals and potential.

Email me at dwalker@patientplacement.com if you'd like the complete free eBook.