Two business people shaking hands

Usually nursing homes and home health agencies can be found at opoosite ends of the spectrum when it comes to referrals.  Nursing homes want the referral to come into the facility for rehab while home health wants the referrals to go home with their services.  I recently found a way to partner with home health care agencies that I hadn’t thought of previously.

In a discussion with a friend in home health care, it was brought to my attention that many times the home health patients may be too expensive for the home health care provider to actually make a profit on.  IV’s meds, daily wound dressing changes, negative pressure, etc. can make a patient very costly very quickly for home health. 

What I propose is to take the referral straight into the SNF for a temporary stay on Medicare Part A - rather than going home on home health – or within 30 days of their hospital stay.  While in the facility, we’ll get the wound on the right path to healing and run the IV antibiotics for a few weeks.  When the resident is ready to come off the IV antibiotics and the wound is healed or at least manageable for the home health company, we give the patient back to them.  They get the same benefit of having the patient on their caseload minus many of the expenses.  The nursing home gets the benefit of a short-term Part A resident and we still make a profit.  The resident receives the benefit of a continuity of care from the hospital to the SNF back to home.  Everyone wins.

Let me know how it works for you.

Share and Enjoy:
  • Facebook
  • Twitter
  • LinkedIn
  • del.icio.us
  • Digg
  • RSS
  • StumbleUpon
  • Mixx
  • Google Bookmarks
  • Blogplay
  • Add to favorites
  • email
  • Fark
  • Faves
  • Live
  • MySpace
  • Ping.fm
  • Reddit
  • Socialogs
  • Technorati
  • Tumblr
  • Yahoo! Bookmarks
  • Yahoo! Buzz
  • Print
  • Sphinn
  • FriendFeed
  • Fleck
  • NewsVine
  • BlinkList
Tagged with:
 

Earlier today, I received a question from someone who is about to step into the role of a Regional Marketing Director and will be responsible for the marketing and census development of multiple facilities.  She asked if I had any ideas on where someone would start if they were entering such a role.  Here is my response:

“…Sure, I have a few things that may help.  Some of these may be slightly redundant as you already have many years of experience.  Also, it depends on how big your company is – if you work for Kindred, Golden Living, Sava, or any of the larger NH companies, they already have some great tools in place.
 
First, a couple of questions:
 
1.  How many facilities will you be responsible for?
 
2.  Will any of the facilities have the same geographic marketing area?  Are any of them in the same city or within 15 miles of each other?
 
3.  Does the company you work for already have resources, tools, tracking reports, marketing supplies accounts, etc. set up for you?
 
4.  Do you have the budgeted numbers you need to run for each facility and as a region – total census, Part A, managed care, etc and are there any plans for introducing a new program to any of the facilities?  The expectation of the facility’s potential may be more than the budgeted numbers on paper.  (i.e.- A transitional care unit can really throw your expected numbers out of whack.  A soon-to-be opened secure unit can be a bad investment if the market need is not there).
 
5.  What managed care contracts does each facility already have and who is working on getting more?
 
6.  Who has final say over the denial of a referral?  The administrator, yourself, or someone else?
 


Some of the first things I’d do if I were taking that role are:
 
1.  Meet with the Administrator, DON, and Marketing Director/Admissions Coordinator at each of the facilities to complete a SWOT analysis.
–>  You need their input on their internal Strengths & Weaknesses as well as any external Opportunities & Threats.
–>  The administrator’s buy-in is crucial; so, make a partner out of them…. no matter how old school they are.
–>  The DON is also a partner and can help expand the service profile of the facility by bringing in education for the staff in order to begin accepting a certain type of patient if you identify a need in the market (i.e.- bariatrics, trachs, etc.)
 
2.  Identify any particular types of referrals the facilities are turning down.  I have had facilities turning down wounds before because they thought they costed too much – without doing a cost-out.  I have had facilkities turn down IV’s for no reason. They have to be reminded nicely that admissions, census development is high priority.
 
3.  Maintain contact with your facilities daily.  This is extremely important especially as you’re starting out in your new role.  At the end of the day, you should have collected all the information on referrals, admissions, discharges, in the hospitals, and denials and keep a running tally.
 
4.  For goodness sake, please go on sales calls with your Marketing Directors.  Many may not understand the mechanics of a cold call or when to make a cold call versus when to schedule an appointment.  What’s the object of the call?  How to turn a sales call into a customer service call… how to help the discharge planner or physician, etc.  You’ll also pick up on bad habits that your Marketing Directors/Admission Coordinators have when doing a presentation that you can help them with.
 
5.  Have the Marketing Directors/Admissions Coordinators build a referral database and keep it updated with their calls.  It needs all the contact’s names, phone numbers, personal information in it.  There are plenty of software programs out there that can help with this; however, I just use an Excel spreadsheet.
 
6.  Help the Marketing Directors/Admissions Directors develop a schedule of when to contact each referral source based on it’s potential.  Categorize each as a primary, secondary, or tertiary referral source and decide how many face-to-face visits, phone calls, faxes, emails, direct mail, etc. to hit each with.  Obviously, these can change with time.  If I visit a certain account every 2 months and every time I go, my referrals from there pick up, I may want to go more frequently.
 
7.  Ensure each facility knows, understands, and puts into practice the principle that referrals do not sit on desks and that callers are not told to call back Monday morning when someone is available.  Set up systems to catch referrals.
 
8.  Develop a Clinical Admission Grid – a grid that quickly and easily identifies what each facility can take or not take.  

9.  Overcommunicate with everyone.
 
10.  Make sure you make all your conference calls and come on prepared.  You have to know your numbers and the reasons why facility A’s Medicare Part A is low this week and how many they have in the hospital, etc.
 
11.  Play nice with everyone on the regional team and pitch in as needed.  If there is a facility is major survey trouble in your region, ask the regional director what you can do to help, even though this may be outside your assigned responsibilities.  It shows you are a team member and willing to help.  It also will help to build that relationship with your regional director or regional nurse to get support when you have an administrator who has to be talked to because he refuses to address a problem employee in the facility’s marketing director role or a DON who refuses to take patients she can accept clinically.
 
12.  Know your Medicare rules.  Your facilities will forget things like - dialysis trips can be billed by the ambulance co. under certain conditions, even though the resident is Part A.  Knowing the rules helps avoid denying an admission over issues that are really non-issues.
 
13.  Make sure not to accept flimsy excuses on why a facility is not taking a referral.
 
14.  Know which meds are extremely expensive and cannot be accepted at the facility.
 
15.  I assume you will be traveling most of the week.  Take an office day once a week.  This will help you get organized, catch up on reports, make any phone calls needed, and give yourself time to strategize for a particular facility’s need.
 
16.  Maintain an environment of success.  Just as the morale inside a facility can be swayed up or down, so can the morale of your troops.  Success inspires success.
 
17.  Maintain professionalism.  No yelling or sharing one facility’s private info with another.  Census numbers and programs are not private, however.
 
18.  If something is going to fail (a new program, a new facility admissions director), make sure it fails quick.  Don’t let it drag out for months.
 
19.  Don’t wait on others to guide you.  Long term care is notorious for our lack of training programs.  If you were successful in a facility as a marketer, you can be assured that most of the people at corporate don’t think you need any additional training.  You may be asked to ride with another Regional Marketing Director for a week and your boss may go over a couple of reports, but that’s about it.  Utilize your resources, make calls to ask questions when you need to.  But, just go after it.
 
20.  Review with each facility their written marketing plan and modify as necessary.  Concentrate on things that get you referrals.   A facility that is 20 beds down may need to think things over if they’re spending all their energy on the upcoming Relay-for-Life while only completing 1 sales call per week.  Which gets more referrals?  If they don’t have a written marketing plan, let me know and I can help with that.
 
Those are a few things off the top of my head.  I hope they helped.  Like I said, they may be a little too basic..  If so, let me know if you run into any particluar issues or any specific crazy problems I may be able to offer suggestions on.
 
Thanks!…”

Obviously, there are a ton of things that I didn’t mention, but basically, these are many of the first things I would tell someone new to the regional role.

What would you tell them?

Share and Enjoy:
  • Facebook
  • Twitter
  • LinkedIn
  • del.icio.us
  • Digg
  • RSS
  • StumbleUpon
  • Mixx
  • Google Bookmarks
  • Blogplay
  • Add to favorites
  • email
  • Fark
  • Faves
  • Live
  • MySpace
  • Ping.fm
  • Reddit
  • Socialogs
  • Technorati
  • Tumblr
  • Yahoo! Bookmarks
  • Yahoo! Buzz
  • Print
  • Sphinn
  • FriendFeed
  • Fleck
  • NewsVine
  • BlinkList

“Leaders are made, they are not born. They are made by hard effort, which is the price which all of us must pay to achieve any goal that is worthwhile.”

- Vince Lombardi

Share and Enjoy:
  • Facebook
  • Twitter
  • LinkedIn
  • del.icio.us
  • Digg
  • RSS
  • StumbleUpon
  • Mixx
  • Google Bookmarks
  • Blogplay
  • Add to favorites
  • email
  • Fark
  • Faves
  • Live
  • MySpace
  • Ping.fm
  • Reddit
  • Socialogs
  • Technorati
  • Tumblr
  • Yahoo! Bookmarks
  • Yahoo! Buzz
  • Print
  • Sphinn
  • FriendFeed
  • Fleck
  • NewsVine
  • BlinkList
Tagged with:
 

paperworkEvery nursing home is required to have at least an annual survey in the range of every 9 – 12 months.  Of course, if you have complaints or are a focus facility, your survey will have a shortened span between them, every 6 months or so.

The goal of every administrator and facility should be to be survey ready everyday.  It does no good to not think about survey all year until the State survey team shows up. 

So, to help prepare for the nursing home survey, here is a list of items that you should have ready.  I usually put these in a plastic file box, organized by number in hanging files.  You may organize them any way you wish.  Do NOT hand this box to the survey team.  Only give them what they ask for.  If you just hand over your information, it may lengthen your survey as it might trigger them to look in areas they had not planned on.

Also, do not hand them your originals.  Make them a copy, because there is a good chance you will not get it back.

 Survey Preparation Files 

  1. Copy of Facility license
  2. Current census – alphabetical with room numbers  (This is how it’s asked for)
  3. Key facility personnel and their locations
  4. Copy of Administrator’s license
  5. Facility layout / floor plan
  6. Surveys / Resident Identifiers for last 3 years
  7. QI / QM – period of last 6 months
  8. 802 – Roster Sample Matrix
  9. 671 – LTC app for MCR/MCD
  10. 672 – Census & Condition
  11. 1513 – Disclosure of Ownership
  12. Information on Resident Rights provided to residents
  13. Meal times and dining locations
  14. Copies of the menu, including therapeutic diets
  15. Medication Pass times by unit
  16. List of admissions in the past 30 days
  17. List of residents transferred or discharged during past 3 months with destinations
  18. Residents with planned discharges in the next 30 days
  19. Current working schedule for nursing staff
  20. Facility admission contract
  21. Facility policies and procedures to prohibit abuse and investigate allegations of abuse
  22. Designated person to answer questions regarding abuse and abuse prevention
  23. Copy of a blank grievance form
  24. Evidence the facility routinely monitors accidents and incidents – blank Accident/Incident Report, Monthly Tracking log and Monthly Accident/Incident Analysis
  25. Current activity schedule calendar
  26. Residents age 55 and under
  27. Residents who communicate with non-oral communication, sign language, or who speak a language other than the dominant language
  28. Medicare residents requesting a demand bill in the last 6 months
  29. Administrator questions
  30. Waivers or variances
  31. QA Committee Members
  32. Resident Council president and minutes – last 3 months
  33. List of interviewable residents
  34. Residents receiving hospice services
  35. Hospice agreement
  36. Residents receiving dialysis
  37. Dialysis agreement
  38. List of residents receiving TPN
  39. TPN policy
  40. TPN agreement
  41. List of residents with negative pressure therapy
  42. Wound vac / negative pressure policy
  43. List of residents who self-administer medications
  44. List of all employees hired within the last 4 months
  45. List of CNAs
  46. CLIA waiver
  47. Medical Director contact information
  48. Ombudsman contact information
  49. TB tests
  50. License verifications
  51. Abuse registry checks
  52. Inservice education
  53. CNA annual required inservice hours
  54. Infection Control team members
  55. Copy of surety bond
  56. Nurse Aide Training class information
  57. Emergency water agreement
  58. Emergency transfer / relocation agreement
  59. Emergency transportation agreement
  60. Influenza / Pneumococcal Immunization policy
  61. Report of Resident Trust fund balances
    1. For any accounts within $200 of the SSI limit, we need evidence of notification.
    2. Discharged residents’ funds dispersed within 30 days
  62. Emergency Supplies Inventory and Needs Calculation
  63. Infectious waste disposal policy, contract, and last shipping record
  64. Standing Orders

Obviously, if you have special programs (ie- a secure unit, mist therapy, etc.) then, have your policies and procedures related to these programs ready as well.  Add those to the list above.

I suggest going ahead and gathering these items now and updating them at least monthly until you are in your survey window.  Once in the survey window, some items will need to be updated more frequently.

You’ll notice that I put your old surveys and your old resident identifiers on the list.  You should absolutely review these and see if any certain issues keep popping up on each survey or any particular residents seemed to be selected every year.  This will help you focus on those areas and hopefully avoid repeat deficiencies.

Share and Enjoy:
  • Facebook
  • Twitter
  • LinkedIn
  • del.icio.us
  • Digg
  • RSS
  • StumbleUpon
  • Mixx
  • Google Bookmarks
  • Blogplay
  • Add to favorites
  • email
  • Fark
  • Faves
  • Live
  • MySpace
  • Ping.fm
  • Reddit
  • Socialogs
  • Technorati
  • Tumblr
  • Yahoo! Bookmarks
  • Yahoo! Buzz
  • Print
  • Sphinn
  • FriendFeed
  • Fleck
  • NewsVine
  • BlinkList
Tagged with:
 
Page 4 of 15« First...2345610...Last »