Over the past 18 months the skilled nursing industry has seen more change than ever before – including a sweeping transformation of our regulatory environment.
Change is hard, and it has placed operators in a seemingly constant state of stress. Yet it also has given rise to opportunities that can revolutionize patient care approach and improve clinical outcomes.
Compliance traditionally has been seen as adhering to expectations of doing things the right way. In today’s “new world,” however, operators that are successfully navigating these paradigm shifts are digging deeper. They are discovering the critical role clinical metrics – incidences of falls, pressure sores, functional declines, unplanned hospitalizations, signs and symptoms of depression, and overutilization of psychotropic drugs – can play in the process.
In 2015 Marquis Health Services assumed operation of a skilled nursing facility with an existing Office of Inspector General (HHS) agreement. Initially, our approach was fairly traditional. We took each metric and attempted to move or improve the numbers in each area. It was a shotgun tactic with a wide range of interventions – we were throwing everything against the wall to see what would stick.
However, we realized early on that it was too time- and resource-intensive to maintain this strategy, especially when we could not easily pinpoint which specific efforts were making a difference.
We developed a proprietary software program that enabled advanced analytics of existing data to expose risk. Consider fall incidences as an example. Examining the data, we saw heightened incidences during the weekend evening shifts. The typical reaction would be to up staffing levels and supervision during those times. Yet digging more deeply, we also discovered the falls were happening primarily in one hallway. Further, that hallway had more falls than any other in our entire facility portfolio. And we were surprised to learn that many incidences tied to one employee – a long-time team member who was both competent and admired.
The cause? The previous operator had inadvertently overburdened this caregiver by giving her more complex and intense assignments than her coworkers, and we had continued the pattern. This had gone on for several years, and she never complained.
Using data analytics we were able to pinpoint the problem and realign staffing to focus resources directly at the root cause of the issue. The resolution was rapid. We were able to do this without adding significant operational expense or overtaxing leadership. That facility today continues to be one of our centers with the least falls.
When we first became involved in this facility the negative implications of the OIG were overwhelming. There was so much extra work and worry. Yet we soon found that it pushed us to find a new way of doing things. The OIG agreement was satisfied a full year early – something virtually unheard of in the industry – not just because facility staff worked harder but, more so, because they had tools that enabled them to work smarter.
Phase 3 of the new CMS requirements for participation, which is currently scheduled to take effect on November 28, mandates that all long-term care facilities have a standing compliance process. While this may seem like another burdensome aspect of “forced” change, it also pushes organizations to strengthen themselves. For Marquis, the processes developed out of pure need for one focused facility have now been adopted companywide. We have seen increased employee engagement and higher resident satisfaction. And, most importantly, these metrics-centered tools are driving better clinical outcomes, quickly and concisely.
Michael J. Smith, RN, LNHA, is the Division President, Marquis Health Services, in Brick, N.J.