Blog by Mark Wolfe, Customer Account Representative, GrandView Pharmacy
One consistent concern with long-term care facilities is how to manage or grow the census of your facility. It seems with such great numbers of Baby Boomers, this would not be a major issue. Baby Boomers constitute those Americans born between 1946 and 1964. Is seems hard to believe, but the truth is that the youngest Baby Boomer is now 55 years old; and they too, may require long-term care soon. The added problem now is that Generation X, those born between 1965-1980, are the ones caring for the elderly. Population shifts are such in the U.S. that as Baby Boomers age, there are fewer and fewer in the population pool to be caregivers. But considering Baby Boomers are still the majority of people seeking long-term health care, they are the population segment that demands the more diversified care. This generation, who was raised on Rock-n-Roll, demands a different type of care than what their parents demanded. However, with so many options available, such as in-home care, home companions, and assisted living, how do you compete to attract more “heads on beds?”
For the sake of this article, we will focus on census management and reimbursement.
First of all, recognize the buyer of your long-term care facility.
Know your customer. Here is a clue… it is typically NOT the potential resident. The focus should be upon the potential resident’s family and loved ones. (1) Gross Mendelsohn Blog, Jim Craig, November 8, 2018). Ask, whether their mom or dad’s care become too much for the family to provide for them? Is the facility close by to allow the family to visit?
Second, building a census is all about the bottom line of the facility.
Is the census at or near the break-even point? With that in mind, what needs to be done to obtain those incremental increases that will definitely affect the financial bottom-line. While few want to say that profit in long-term care is bad, the reality is that if the facility does not have a healthy financial condition, the prognosis for continuing to offer health care is not so healthy.
What are the capabilities of your facility and staff?
Are you a skilled nursing facility who offers acute care, or are you offering intermediate care? What services does your facility provide? Consider the census may grow if you offered, for example, IV therapy; peripherals, mid-lines, PIC lines, etc. Rather than need to transfer residents to hospitals to access intravenous therapy. Offering in-home IV therapy may be preferred; as to keep from “yo-yo-ing” the resident back and forth.
Let’s examine this for a moment. In the long-term care setting, respiratory tract infections (RTI) and urinary tract infections (UTI) are the leading diagnosis. With IV antibiotics being the leading treatment initiative at the Emergency Department, it leads to a hospital stay. (2) Canadian Geriatrics Journal; Papaioannou, A; etal; Dec 30, 2018). Rather than a discharge with a short-term hospital stay, why not perform therapy within your long-term care facility? Papaioannou concluded, IV Therapy is feasible to implement in long-term care. Of course, while working to eliminate the occurrence of both RTI and UTI are desirable, that becomes a discussion for separate article. The use of IV therapy most certainly can increase census and can even begin to label the facility as a facility that is excellent at providing such care. Similarly, you may consider offering in-home dialysis.
PDPM: In the ‘old days’ long-term care administrators concerned themselves with census, just like today. However, at that time the language was “payer mix,” maximizing your Medicare dollars, etc. In today’s Medicare Patient-Driven Payment Model (PDPM), it makes the use of clinical assessments; the driving force in resident care decisions. PDPM is the major overhaul to current long-term care facilities. The revisions to reimbursements is due to a patient’s clinical characteristics rather than the number of therapy minutes provided to the patient. (3) CMS Finalizes Dramatic Overhaul of SNF PPS, effective October 1, 2019.
A skilled nursing facility located in Illinois calculates an additional $1 million in yearly revenue by adding dialysis services to their skill-set. Doing so requires partnering with a third party vendor, additional training and investigating the significant variances in state regulations. (3) Skilled Nursing News, Maggie Flynn: March 27, 2019. However, with the new PDPM, there are definitely rewards to those providers who offer more complex services.
Granted, “While reimbursement for rehab is going down, the reimbursement for acuity is going up,” so says COO, Josh Rothenberg, of Dialyze Direct, Carmel, IN., “Nursing facilities need to find a way to bring products into their buildings that will incentivize those patients to come into their building.”
Your representatives at GrandView Pharmacy are willing and able to partner with you, along with any third party vendor you may select, as you work to meet your census challenges head on.
About the Author
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