How an operational assessment can change your organization
Cyndi Taplin, Director of Consulting for LeaderStat
A ‘consultant' is defined as “a person who gives professional or expert advice.” However, in our experience a good consultant will go far beyond advice. They will conduct a thorough financial and operational assessment and partner with your organization to implement changes that will increase occupancy and reimbursement, and more efficiently manage labor and expenses. Here we lay out the hallmarks of a good senior living industry consultant and what a thorough operational assessment looks like.
First, a good consultant must be an insider in the industry, who specializes in senior living care and has worked in the trenches in a past leadership position. They will have up-to-date familiarity with reimbursement rules and compliance standards, and will need no lead time to get familiar with job descriptions and industry standards. However, a great deal of time will be taken to get to know the organization. In fact, a proper assessment begins with introductory and pre-visit conference calls, detailed, in-depth analysis of information provided via Request for Information (RFI), and the development of interview and audit tools before the consultant even walks through the front door.
The next steps include gathering information on-site with a kick-off meeting, facility tours, and interviews with residents, families, employees, and the management team. A skilled consultant can conduct interviews that make residents and staff feel comfortable enough to divulge their true thoughts about the deficiencies of the organization without letting the interviews become nothing but a venting of frustrations about staff or leadership. Consultants will gain an understanding of the organization's structure and culture, and assess marketing, reimbursement, therapy programs, labor management, and expenses, including an audit of the business office.
A thorough marketing review begins with a market position analysis that includes a review of competitors, stakeholder perceptions, census trends and discharge management, referral source analysis and perceptions, physician coverage, and clinical capabilities. Next, the consultant will review the systems and processes (such as marketing plans and management of sales calls), the strengths and weaknesses of the sales team, and the effectiveness of current marketing communications.
The next crucial step to an operational assessment is a financial, labor, and expense analysis. A consultant worth his/her salt will become intimately familiar with the organization's budget, accounts receivable, ancillary supplies, staffing costs, and scheduling practices. Reimbursement is studied by assessing ADL documentation, handling of medical record requests, cut letter review systems, therapy delivery, MCR/UR review, MDS assessment type coding, and your Electronic Medical Record system usage. All assessments should be done with an eye for increasing efficiency (to reduce costs), and maximizing reimbursements.
The business office audit should be comprehensive and include meticulous reviews of the systems in place for accounting, managing cash flow and collections, handling managed care, Medicare, and MyCare, as well as EMR implementation. Business office staffing will be considered, and forms will be reviewed for redundancy and updating. Lastly, therapy areas should be considered with an evaluation of clinical programs, documentation, and optimal implementation and configuration including making recommendations about separate skilled care areas.
For many consultants, the job ends here, but a true operational assessment is not complete without implementation and follow-up. For each area assessed, a detailed and specific action plan should be provided, with individual, objectively-assessed, actionable items that includes long-term follow-up to monitor and manage progress and accountability. Experienced consultants excel in presenting problems and deficiencies in a way that creates a shared sense of focus and responsibility, rather than a fractured culture of blame, and successfully gets both staff and leadership invested in the implementation.
A well-executed financial and operational assessment can change the culture of a facility from one of blame to one of cooperation, improve system and process efficiency, increase occupancy and reimbursements, decrease costs, and turn a surviving organization into a growing and thriving one.
Cyndi Taplin, BS, NHA, QCP, is the Director of Consulting at LeaderStat. She works with providers nationally to improve their financial and clinical results to improve operational performance.