Steven Littlehale

In a skilled nursing environment driven increasingly by data, providers must know which metrics matter most to their stakeholders — and be willing to work hard to improve those that exist beyond the consumer’s gaze.

That was the main takeaway from a webinar hosted Wednesday by Steven Littlehale, a gerontological clinical nurse specialist and chief innovation officer at Zimmet Healthcare Services Group.

Many providers find themselves consumed with easily accessible or public-facing data, such as that posted on Medicare Compare or by placement companies on social media. But other stakeholders, including referral partners, investors and lenders, are looking at much deeper data points.

“You are dealing with so much data right now, and you don’t have time to address all of it. You can’t be accountable to all these different programs that are being thrust upon you,” Littlehale said. “So we have to figure out what is the most important metric to focus in on to give you the best position in the marketplace.”

Ultimately, better metrics can help fill beds. Littlehale noted that nationally, the skilled sector is losing occupancy, even when accounting for beds going offline. That increases the financial pressure to snag market share.

“You need to keep the lights on in your building, and the way you pay utility bills is by caring for people, fulfilling your mission caring for elderly people,” Littlehale noted.

Despite a data deluge that now requires providers to feed data into CASPER, the Payroll Based Journal staffing system, MDS SPADEs, value-based programs and other quality incentive programs, Littlehale maintains the two most important data factors for most providers remain the Centers for Medicare & Medicaid Services’ Five-Star Quality Rating System and staffing measures.

But staffing is gaining ground quickly. Earlier this year, CMS added several new elements representing turnover and weekend hours to its staffing calculation. And then it adjusted how it calculates the staffing portion of Five-Star, a change that stripped thousands of providers of a needed bonus in their overall calculation.

Give them a little ‘something-something’

Littlehale shared several anecdotes of hospital discharge planners and others pointing consumers directly to staffing ratings when deciding where to seek post-acute care, despite a prohibition on such behavior. But it’s clear those metrics sway more than just referrals; they also affect how providers are viewed by would-be network partners or managed care providers.

“They all want data to help determine if you’re the provider of choice, or not,” he said. “They all have their own data needs. They have their own accountability and are looking at and needing certain kinds of data to justify their positions. For them to be successful, they need a certain ‘something-something’ from you.”

Knowing what those data points are, understanding how they stack up against peers and getting them up to where they should be to drive new business is a key improvement strategy, he said.

Managed care partners, for instance, might waive Medicare’s three-day stay requirement among facilities that score three stars or more in the Five-Star system. Those scoring lower will be at an automatic disadvantage in their markets. For Medicare Advantage plans, it’s important to be aware of potential growth and to see what the area’s largest plans require from their contract holders. Once those metrics are known, work toward hitting required thresholds.

Other data points can help providers find unidentified needs and build care proficiency and capacity. As an example, Littlehale noted areas that have high projections for future Alzheimer’s cases could present opportunities to providers in that space.

“If I’m an operator in that neck of the woods, I want to start thinking and planning and anticipating,” Littlehale said.

Still, for overall performance, Littlehale said the best driver of referrals and other benefits continues to be the overall Five-Star score.

He said the connection between a higher Five-Star rating and occupancy “couldn’t be more clear.” But for providers worried about razor thin, or negative, margins, there are plenty of other key considerations tied to the number of stars secured.

Chief among them, in almost all states, Littlehale said: As stars increase, so do the shares of Medicare and other, non-Medicaid patients for whom payers reimburse at more reasonable rates.

He also offered tips — ranging from checking submission accuracy to eliminating redundant paperwork to improve workflows — that providers can pursue to improve their data.