Blog
by Bent Philipson | September 3rd, 2021
The United States is referred to as a melting pot for a reason. This nation has always been culturally rich, with people from all areas of the world bringing their unique backgrounds together. But according to data from the U.S. Census Bureau, the United States continues to become more racially and ethnically diverse than ever before.
The Census Bureau found that Asian and mixed-race individuals represent the fastest-growing segments throughout the U.S. The states with the highest diversity index include California, Hawaii, New Jersey, and Maryland, just to name a few. What does this mean for the healthcare sector, exactly? As the population continues to change, the healthcare industry and its executives, physicians, and nurses must change along with it. All healthcare staff must be able to adapt to the unique backgrounds and needs of every patient that walks through their doors.
The healthcare industry has made steps to adjust to the distinct care needs of culturally diverse patients, but we still have a long way to go. One thing that healthcare facilities, especially skilled nursing and other long-term care centers, must do is recognize issues that can impact cultural sensitivity within their organizations. Below are two examples.
Language barriers
While English is the most commonly spoken language in the U.S., not every patient you see will be bilingual. This is especially true for older generations. While these patients might have a child or grandchild who can help translate for them, there may be some instances where this isn’t the case. Either way, your facility must be proactive in its inclusivity.
Rather than relying on the graces of a family member for communication, find and hire staff that is fluent in some of the most common languages spoken in the U.S., like Spanish and Chinese. This will help make the patient feel more comfortable and supported throughout their stay. This is even more critical for patients with Alzheimer’s or dementia, as these neurological conditions can make bilingual patients forget their second language, which further hinders communication.
Cultural assimilation
Being a minority in a healthcare environment can cause significant distress, especially at skilled nursing facilities where patients demand long-term care. Language barriers and differences in social norms can make patients feel uneasy, or even worse, threatened. It’s important to understand the unique mannerisms and beliefs of patients, which should then be used to inform their transition into your care.
For example, Japanese patients believe that being too expressive is impolite, so they might hold back important medical information that can impact their diagnosis and treatment. Asian and Muslim women may feel uncomfortable wearing a hospital gown, as their religious beliefs demand a higher level of modesty than other cultures. Lastly, Mexican patients may seem uninterested in traditional recovery options, as they often use different healing practices to overcome their ailments. The better you know your patients and their backgrounds, the better able you’ll be to create an environment where they feel safe and comfortable.
Cultural diversity must be an asset within every healthcare facility, big or small. Your staff must learn how to support every patient population so that you can welcome any person into your center and extend the same sensitivity and care to everyone.
Issues That Can Impact Cultural Sensitivity at Skilled Nursing Facilities
What’s New in Wound Care Technology
by Bent Philipson | April 15, 2021
The body’s ability to heal itself is quite extraordinary, but in many instances, proper healing will require the intervention and assistance of qualified medical professionals. This is especially true in long-term care centers and skilled nursing facilities.
It’s no surprise that elderly patients don’t heal as quickly as younger patients. Aging skin can make wound healing four times slower than usual, which can have pretty severe consequences on a patient’s overall health. This makes wound care a critical service that not only plays a significant role in patient welfare at LTCs and SNFs, but it can affect everything from reimbursement to staff efficiencies.
Over 25 percent of elderly patients are reported to have at least one wound upon admission to a hospital. Around 2 million of these patients either come from or end up in a long-term care center or skilled nursing facility. It’s crucial that these centers stay on top of new innovations in wound care technology so they can better diagnose, treat, and monitor their patients’ chronic wounds.
Below are a few exciting breakthroughs in wound healing technology that will shape the industry for years to come.
Smart beds for ulcer prevention
Bedsores are the leading cause of open wounds in bed-ridden patients at long-term care centers and skilled nursing facilities. These bedsores, which are also known as pressure ulcers, are brought on by constant friction and pressure on the skin. If left untreated, these ulcers can develop into infections, tissue death, or gangrene. Smart mattresses can track a patient’s movement, temperature, and positioning and then use that information to redistribute a patient’s weight and contour to their body to reduce unwanted pressure on their ‘hot spots’ — all of which can be done without a nurse in the room.
3D wound imaging cameras
Measurement is a critical aspect of wound care, whether you’re treating ulcers or other chronic wounds. Before technological advancements in wound healing technology, medical professionals used paper rulers and Q-tips for depth measurement. Not only did this prove a time-consuming process, but it was fraught with inaccuracies. Today, 3D imaging cameras allow staff to measure and map wound progression over a period of time. Being able to observe changes in tissue structure and volume is essential to effective treatment, thus improving the patient experience and helping to heal even chronic wounds such as diabetic foot ulcers.
Vacuum-Esque bandages
Using vacuums in wound care isn’t a new feat, but these typically required the use of small battery packs that didn’t hold much of a charge and made traveling difficult. Researchers from Australia expanded on these capabilities to make them more effective and convenient than ever before. Their fast-acting vacuum plaster connects to a pump the size of a smartphone, which creates negative pressure that removes dead tissue and other harmful bacteria and debris from a patient’s wound. Additionally, these small, lightweight dressings also increase blood flow to encourage faster healing.
Hyperbaric oxygen treatments
The doctors and staff at Philosophy Care affiliated nursing homes work to provide residents with individualized treatment plans based on their specific needs. One of the interventions used across these centers is hyperbaric oxygen treatments (HBOT), which are commonly used to treat wounds, infections, and other temporary conditions.
A physician or nurse might choose to implement HBOT for wounds that are not healing normally and in instances of certain types of toxicity. Hyperbaric oxygen treatments are often used to treat diabetic wounds, anemia, intracranial abscess, necrotizing fasciitis, osteomyelitis radiation injury, skin grafts, and serious burns, among others. They are also revered for their ability to improve a resident’s chronic neurological, vascular, and ophthalmic conditions as well.
Philosophy Care is proud to guide facilities through advanced solutions for wound healing. Their WOC nurses are the staff with the most up-to-date knowledge of pressure injury prevention and treatment and are experts in wound assessment. They serve as the bridge for physicians whose patients are either at risk for wounds or have skin integrity issues that demand attention.
By utilizing the best in wound care technology, the treatment used by these skilled nursing facilities is conducive to a quicker and more efficient recovery. The future of patient-centered care relies on innovations in wound care and other healthcare technology, and centers that want to usher in this change must be diligent about implementing these new advancements within their facilities.
The Importance of Healthcare Staff Education (Especially During a Crisis)
By Bent Philipson | Wed Sep 30, 2020
Healthcare staff education can literally be a life-saver, but it’s an initiative that often gets far less attention than it deserves. Unfortunately, that lack of education is to the entire industry’s detriment: preventable medical errors are now a serious public health problem in the United States and contribute substantially to rising healthcare costs, among other issues.
Is it any wonder, really? Medical advancements, technologies and guidelines change at a rapid pace and can significantly alter the way care is provided. If healthcare workers are not in the loop and trained sufficiently, how can we expect them to adapt to a changing landscape and provide the most effective care?
The impact of COVID-19 over the last few months has made the importance of ongoing education abundantly clear. The crisis has completely upended the way healthcare workers have traditionally taken action to prevent themselves against the spread of disease. The National Institute of Health recently launched a website with critical educational resources in an effort to promote training programs to protect high-risk employees. With limited PPE available to healthcare workers, they’re learning to adjust with what’s available to them while still preserving their safety.
Hospitals and healthcare facilities across the world are having to take additional precautionary measures to ensure that staff and patients remain safe. Our network of skilled nursing facilities is no different; we’ve had to follow recommendations from the NY State Department of Health and the CDC and implement changes like requiring staff to wear facemasks at all times, asking our residents to remain in their rooms, and adjusting staff schedules to minimize the risk of exposure.
Every day is a balancing act for healthcare staff. Their performance, especially during a crisis, is heavily influenced by the structure of the organization’s internal staff education program. Everything from formal orientation to the maintenance of professional skills to their career development is directly tied to their success, but it’s also linked to the proficiency of the organization as a whole.
When you prioritize education, there are a number of payoffs you’ll see trickle throughout your entire operations. Here are a few of them.
A lower turnover rate
Employee retention is one of the biggest issues currently facing the healthcare sector, especially as we continue to feel the impacts of COVID-19. While the rest of the world is under quarantine, healthcare workers are still manning the frontlines of this pandemic. But underneath the calm, focused demeanor they put on while they’re at work, they are experiencing higher levels of depression and anxiety.
Working in healthcare is a tough job. That should go without saying, but it bears repeating. Rewarding though it may be, it’s easy to become burnt out, especially in today’s climate. Healthcare workers are working long hours and, just like their patients, they’re worried about their own health. Many have chosen to socially distance themselves from their family.
If you want to keep your employees, show them you care by investing in their professional development. Hiring competent people and paying them a competitive salary simply isn’t enough. You also need to show a sense of dedication to your company culture, staff retention programs, and of course, ongoing education. If your employees aren’t finding that at your organization, they may seek it out with one of your competitors.
Creating a positive environment
An organization that prioritizes ongoing education generates a positive, motivated, and energetic workforce. How you continue to mold your company culture during a pandemic looks a bit different, but it’s even more critical now — you just have to get creative.
Some facilities, when possible, are encouraging their staff to conduct more televisits. You have technology at your disposal, so are you taking full advantage? Train your employees on how to utilize videos and online chat tools to safely interact with patients. Employees want to feel empowered to do their jobs as best they can. That means training them on how to leverage what’s available to them so they can continue providing the best care to their patients while still complying with policies and safety protocols.
This isn’t only felt by staff, either; this translates to patients and residents as well. Compassion matters when it comes to the patient experience. By prioritizing your employees’ professional and personal development, you create an environment that’s welcoming, calming and cheerful. As a patient, wouldn’t you rather your medical provider have that kind of bedside manner instead of the alternative?
More efficient operations
You can’t have more efficient operations without proper training. If your training structure isn’t sound from day one, you already risk losing the talent you just hired. To return to the point about employee turnover for a moment, not having a good orientation program is cited as one of the top ten reasons why caregivers leave their agencies. Decreasing your turnover rate eliminates the rapid-fire cycle of hiring, acclimating, and training new employees.
If you’re an innovative facility that’s focused on serving as much of your community as possible, your staff needs to be equipped to handle the constant changes in regulations, policy, and technology. An organization in Boston, for example, started using artificial intelligence and set up a hotline where they could separate patients with less serious symptoms from the small subset of patients that are higher-risk. Of course, that implementation doesn’t happen on its own. Employees had to be trained on how to interact with the new AI software, as well as how to transfer patients to the correct virtual care center or hospital.
When people’s lives are on the line, staff education is no joke. Healthcare workers need to understand how to provide the best care to their patients, whether or not we’re in a crisis.
The challenges we face today with the global pandemic are more pressing than nearly anything else that has come before. The future is uncertain; the circumstances are complex and stressful. Your healthcare workers are brave and motivated enough to face these challenges daily and ensure that their communities stay healthy and strong. The least we can do is invest in their education and ensure that they have the tools and resources they need to face the future with certainty.
The Modern-Day Challenges Facing the CEOs of Healthcare Facilities
by Bent Philipson | Wed Sep 30 2020
Healthcare is one of the most rapidly evolving industries, and for good reason. While stagnancy within any other industry may curtail a company's competitive advantage, stagnancy within the healthcare sector can be life-changing. It compromises our ability to provide the highest level of care to patients in need.
In order to do right by our patients, the healthcare system must continue to evolve. And while this transformation is necessary, it also poses certain challenges to our existing infrastructure.
As such, CEOs of healthcare facilities often find the healthcare landscape a difficult one to navigate. For example, virtual care has completely transformed how doctors and patients communicate with one another. The COVID-19 pandemic has put telehealth capabilities to the test, proving all the more how digitized healthcare is revolutionizing the industry. But while all signs point to radical change, the U.S. healthcare system is impeding widespread adoption.
Throw in other age-old issues like talent acquisition, regulation changes, and increasing oversight and it's clear that healthcare leaders face immense pressure influencing change in such a dynamic field. Implementing effective solutions is only possible when leaders fully understand these challenges and how they could impact their organizations.
Staying on top of technological advancements
Emerging technology is critical to the betterment of our healthcare system. It's not only the most effective solution for better care, but it also lessens the impact healthcare organizations and patients feel when there are complications within the industry.
The Association of American Medical Colleges (AAMC) predicts that the U.S. will experience a shortage of 122,000 physicians by 2032. COVID-19 is only worsening the impact of this shortage as doctors, nurses, and other healthcare staff who become sick are having to be pulled from their workstations. The larger reason for the shortage isn't because professionals are leaving their positions, though -- it's because the population continues to age at an alarming rate. To account for people living longer lives and making sure everyone has equal access to healthcare, it's currently estimated that the United States would need an additional 95,900 doctors and nurses.
But that's not going to happen overnight, or even within the next decade. This is where we see technology's biggest benefits. As healthcare organizations face staff shortages, virtual care options help pick up some of that slack. Telehealth consultations reduce wait times by 20 percent and allow professionals to more easily treat common health conditions and manage chronic illnesses that require more frequent touchpoints.
Telehealth's benefits are undeniable, so why aren't we seeing it everywhere? Sometimes knowing something is good isn't enough to set it in motion. Healthcare leaders must introduce virtual care into their existing workflow in a way that feels effortless, they must understand how it fits into their bigger organizational goals, and then they must incite user adoption, which is especially difficult to do with older generations.
Cybersecurity concerns
You can't talk about technology without talking about privacy and security. One of my biggest undertakings as CEO of a New York nursing home has been converting our organization to the cloud. Cloud adoption is a no-brainer, but data security and HIPAA compliance concerns are a real threat.
In 2018, over 471 million patient records in the United States were exposed by cyberattacks. Cloud technology is meant to enhance patient care, but when patient information is compromised, it can have dire consequences. Just a few years ago, healthcare organizations were exposed to the worst cybersecurity attack in history.
The attack happened after a cyber gang called Shadow Brokers released ransomware called WannaCry and wreaked havoc across the world. More than 20 healthcare organizations were affected; in some instances, doctors and nurses even had to turn patients away and cancel life-saving surgeries. And there are countless examples like this.
The healthcare industry holds some of the most sensitive information available, yet it fails to adequately address information security. When asked about their cybersecurity efforts, over 81 percent of healthcare executives have reported that their organizations experienced some level of attack within the last few years. This hasn't only proven costly for the healthcare system, but it puts patients lives at risk.
Shifting from volume to value-based care
The healthcare industry is finally recognizing the need to move from volume to value-based care. Fee-for-service has been commonplace for so long, but we're seeing more organizations start to implement fee-for-value structures instead.
In volume-based care, a successful system is measured by high-profit margins not the quality of care. The opposite is true in value-based care, which takes a holistic view of patient health and services. Because healthcare executives have the best interest of their patients in mind, they work to connect their department initiatives and their ongoing staff education to match that end goal.
Value-based care is the solution to what is wrong with our current healthcare system. It reduces healthcare costs, particularly for those with chronic health conditions, which are influenced by patient outcomes. It also leads to healthier populations. In a world where half the population doesn't have access to essential, life-saving services and 13 percent of Americans — or around 34 million people — know one person who has died from not being able to afford critical medical attention, value-based care is the answer.
Yet, most monumental change comes with hurdles blocking widespread adoption. Some healthcare CEOs lack the operational wherewithal to implement these initiatives. Value-based care also requires specific technology in order to be successful. Going back to the struggles some healthcare leaders have with technological inclusion, this often becomes another setback.
We are at the forefront of systematic change. For healthcare executives, riding this sea of change is difficult, but we must. As we move forward, we need to question and challenge the outdated and traditional processes, resources, and procedures that were once revered in the past. There will be hurdles to face every day, but when your focus is on your patients and staff, overcoming these barriers is worth it for the healthcare industry’s future, and theirs.
How Technology Has Senior Care Soaring Into the Cloud
Imagine that you're an elderly diabetic patient in your early 80s. Today you're having a routine checkup with your doctor just to make sure everything is in tip-top shape. But instead of going to a doctor’s office, you simply log on to your computer for a brief consultation.
With just a few clicks, your doctor uploads all the data from your wearable device so they can take a look at your blood glucose levels and vital signs. Your appointment is over in a matter of minutes. You didn't have to find transportation to the doctor's office, nor did you have to schedule your entire day around the appointment. In fact, all you had to do was open your computer for a routine checkup.
This may sound like a futuristic scene out of a sci-fi movie, but cloud-based technology has made this a present-day reality for seniors.
The senior care industry has historically been slow to adopt technological advancements such as cloud solutions for a number of reasons, not the least of which concerns data security and HIPAA compliance. To make matters more complicated, a high volume of patient information would need to be converted to the cloud, and we’d be asking significant behavioral changes of a generation not particularly well-known for its technological proficiency.
But an increased fervor in cloud adoption couldn't have come at a better time. With COVID-19 affecting seniors more than any other age group, telehealth has become a prudent alternative for certain in-person doctor visits. Medicare recently expanded their coverage for telemedicine to ensure that seniors are still getting the medical attention they need, while also keeping them safe from avoidable exposure.
Beyond the current pandemic, ten thousand people are also set to turn 65 every day for the next 20 years in the United States alone. Longer lifespans mean an increased need for medical care. One in five boomers have already been diagnosed with diabetes. Over half of their generation has been prescribed pills to lessen the effects of hypertension, which is all the more important because 40 percent of boomers are considered obese. And this list is just the tip of the health-issues iceberg. It's projected that by 2030, 60 percent of the generation will be managing more than one chronic health condition.
Caring for an increasingly aging population will continue to put a strain on senior care unless we embrace new solutions that account for these demographic shifts. Thankfully, that shift is well underway.
Technology isn't just a young person's game anymore. An increasing number of seniors now own smartphones and various smart devices. Over 17 percent have even started using wearable devices in their everyday lives. Younger generations may covet wearables to track their fitness and weight loss journeys, but the advantages extend far beyond counting calories.
Smart devices can now measure a person's heart rate, blood pressure, body temperature, and oxygen levels. One new gadget can even analyze blood sugar levels without an incision. Others can detect falls in real-time and will send an alert to a call center that will immediately dispatch emergency services to the person's home.
Wearables give seniors peace of mind knowing they're protected if their health would take an abrupt turn for the worse. Gone are the days of countless tests to pinpoint what's causing the health issue, and weeks of having to wait for those test results to come back. With wearables, a physician or nurse can remotely monitor a patient’s vitals from afar, alleviating the strain on the senior care system and minimizing unnecessary, routine appointments.
Many seniors worry that remote checkups won't allow for the same quality of care, but the evidence indicates otherwise. A recent study shows that telemedicine results in 38 percent fewer hospital admissions, 31 percent fewer readmissions and over 60 percent of people spend fewer consecutive days in the hospital.
Remote monitoring can also help seniors take control of their own health on a more regular basis. Say someone suffers from a severe heart condition, for example. By monitoring their vitals, a patient’s wearable device can incentivize them to stay away from salty snacks that could have dire consequences. These technologies are so advanced they can even signal whether a heart palpitation is being caused by indigestion or is a sign of something more serious.
It's common for seniors to live more sedentary lifestyles, especially those that struggle with physical ailments or other chronic health conditions. But we know that sedentary lifestyles worsen the majority of health issues, which is why an age and health-appropriate exercise regimen is so important for longevity and stamina. Just as wearables can monitor medical conditions, they can also keep seniors on track with their health and activity levels, providing a much-needed breath of independence.
While cloud technology’s advantages are significant, they are not without challenges. While the U.S. Department of Health & Human Services temporarily loosened HIPAA restrictions to allow greater access to telehealth during the COVID-19 outbreak, it is unclear to what extent that will remain so afterward. Similar uncertainties surround Medicare’s expanded telemedicine coverage.
Also of particular importance is ongoing staff education. In order to provide the best care to patients, nurses and physicians need access to updated policies, procedures, and resources that inform care and treatment options. Thankfully, the cloud also makes staff education easier, serving as a one-stop database for guidelines and changes in treatment, technology, and protocols.
Cloud technology allows healthcare facilities to achieve the holy grail of senior care: it's cost-effective, it allows for operational efficiency, and it encourages better outcomes through patient independence. It is not a replacement for face-to-face care, but it does provide much-needed support to a heavily strained system. The level of care we provide to residents and patients only goes as far as the innovations we choose to enmesh within our operations. If we don't take cloud technologies seriously, we only hurt those we claim to serve.
Embracing Diversity Will Secure Innovation and Profitability
by Bent Philipson | Wed Sep 30 2020
There is no shortage of advice when it comes to helping companies become more innovative. Innovation is what breaks the constraints of outdated methods and can transform entire industries. The problem is that a majority of these opinions are anecdotal and what works for one organization might not work for another, especially if you are crossing over industries.
But there is one piece of advice that is rooted in facts. Diversity in an organization's leadership will engender innovation and drive better financial performance. Now, this isn't breaking news. A 2016 report found that a more diverse representation in senior management will lead to greater profits. In 2018, another study confirmed the same findings. And so on.
This is huge for startups and tech companies that rely on innovation to maintain a competitive advantage in their industries, but it's even more persuasive for healthcare organizations. Despite efforts to drive progress, healthcare has remained at the edge of radical innovation. Innovation must become a priority where it's not already to reduce spending and improve patient care.
Healthcare executives that start making small adjustments to the makeup of their senior teams now will soon experience accelerated results.
Diversity as a business practice, not just a metric
There's never one way to solve a problem. We know this from our own experience in the workplace, even if we don't come from all-inclusive organizations. But as Katherine Phillips, a Columbia Business School Professor, writes: "Diversity jolts us into cognitive action in ways that homogeneity simply does not."
Our ingenuity and unique approach to problem-solving is influenced by who we are and where we're from. If the people around the leadership table all look and think like you, it's more likely to spur complacency and uniformity in thought, which is the enemy of innovation.
Differences in leadership is like a melting pot of ideas and perspectives. Sharing these viewpoints forces others to consider opinions unlike their own. As such, preparing and communicating these points demands a deliberate, methodical approach that will feel like more effort, but will prove invaluable over time.
When leaders are accustomed to diversity, they are able to recognize new opportunities to support untapped markets and unmet needs. In an industry like healthcare that is constantly evolving and toeing the line of change, this level of adaptability is what innovation requires.
We talk about the future-forward impacts of diversity, yet what does a diverse leadership team really look like? In healthcare, this is a critical concept to consider because it doesn't only impact business success, but also patient outcomes.
Healthcare executives must reflect the patients they serve
Traditionally, the umbrella of diversity included people of different genders, races, and ethnicities. According to one study, companies in the top quartile for gender diversity were 21 percent more likely to experience above-average profitability. The same study also found that ethnic and culturally diverse teams were 33 percent more profitable than homogenous teams.
While profound, diversity now contains a much larger spectrum, including lifestyle choices, sexual orientation, experience, and social determinants of health. Organizations that include representation from all of these areas are 45 percent more likely to report a growth in market share than other facilities.
But we have a long way to go. Research has found that minorities represent around 32 percent of hospital patients, while only 14 percent of hospital board members and 11 percent of healthcare executives. This data is similar to a 2013 survey conducted by the American Hospital Association's Institute for Diversity, which is alarming.
A healthcare organization can't fully understand the needs of its patients, nor can it influence the necessary change to improve care and treatment for these demographics, unless members of the leadership team reflect the patients they serve. The healthcare industry demands inclusivity, and a diverse management team gives a voice to those whose lives are in jeopardy if the change is not enacted.
This is even more compelling in the midst of a global pandemic as communities everywhere are being hit hard by the coronavirus. It's been proven that pro-diverse facilities have been able to successfully weather the storm of past recessions, not only because of their stronger business solutions but because they're better able to make patient care the center of their focus.
The healthcare industry is crying out for real, equitable change. This is only possible when healthcare executives take the initiative to prioritize diversity in their leadership teams. While innovation is necessary for better patient outcomes, it also improves profitability and increased performance for organizations themselves. It's a win-win-win.
COVID-19 Crisis Underscores Advantages of the Patient-Driven Payment Model
by Bent Philipson | Wed Sep 30 2020
The efficacy of the Patient-Driven Payment Model (PDPM) has never been clearer than now, in the middle of the coronavirus pandemic.
The PDPM, implemented on Oct. 1, 2019, enabled skilled nursing facilities to see a nine percent increase in Medicare reimbursement in the early days of the outbreak, according to analysis conducted in April by Zimmet Healthcare Services Group and Claim Outcomes and Reimbursement Essentials (CORE), a data firm.
Reform was certainly much-needed, given the state of U.S. healthcare. It has long been clear that the average American doesn’t receive the best care possible, despite the nation leading the world in spending in that sector. That has been particularly true of seniors. While the government spent $782 billion on Medicare last year, consistent, high-quality care for those 65 and over was elusive.
The Centers for Medicare and Medicaid Services (CMS), understanding the issue, created the PDPM in hopes of simplifying an overly complex payment method, trimming costs and improving senior care across the country's skilled nursing facilities.
Pulling the RUG out from under the system
The PDPM is the first radically different reimbursement system in over 20 years, and shifted how the CMS pays skilled nursing facilities for their Medicare patients. Under RUG-IV -- i.e., Resource Utilization Groups Version Four -- Medicare rates were based on the number of therapy minutes provided to any given patient. By contrast, payments are now doled out according to a daily reimbursement rate determined by patient classification.
The new classification is driven by the ICD-10 code (i.e., the International Classification of Diseases, Tenth Revision, Clinical Modification), as well as clinical assessments of each patient’s care needs and co-morbidities. In other words, this payment method is driven by the needs of the patient, not the services rendered. Moreover it takes into account skyrocketing pharmaceutical costs and enables providers to meet the needs of more medically complex patients. It will also make possible improved data collection -- and that in turn will increase the likelihood of patients making informed decisions about the skilled nursing facility that will best meet their needs.
Under RUG-IV, there were just two classifications -- therapy and nursing. That number would have doubled under its first proposed replacement, Resident Classification System 1 (RCS-1), which was similar to the PDPM and would have included physical and occupational therapy (PT/OT), speech-language pathology (SLP), non-therapy ancillary (NTA) and nursing. But before RCS-1 was ever implemented, the CMS announced the adoption of the PDPM in April 2018, which added a fifth classification by dividing physical and occupational therapy.
The implications during the pandemic are obvious. Seldom have so many patients had greater needs than at present. Seldom have those with certain pre-existing conditions been at greater risk.
Improved efficiency
The expectation is that implementation of the PDPM will reduce the paperwork required of providers, since tracking the volume of services, as was required under RUG-IV, was far more complicated. As a result, there are now more opportunities for staff-patient interaction, which has taken on added importance during the pandemic, when the influx of patients has been far greater than usual.
Another necessity (especially now) is greater interoperability between providers. Hospitals require a clearer view of a skilled nursing facility’s ability to care for complex patients -- and those suffering from coronavirus certainly fall into that category -- which goes hand-in-hand with improved record-keeping, and specifically with electronic health records (EHRs), which are already in vogue.
The result of such changes has come to be viewed as a net positive for the industry. As Genesis CEO George Hager said when the PDPM was unveiled, it allowed those in the industry to better manage “significant cost elements” like that of providing rehabilitation therapy. And indeed the CMS estimated at the time that the measure would result in a system-wide savings of $2 billion over the following decade.
At the same time, there is the matter of increased revenue. Jennifer Leatherbarrow, a senior clinical consultant at Ohio-based Richter Healthcare Consultants, noted that while skilled nursing facilities will make less off patients who require extensive therapy under the PDPM, such facilities will “get paid substantially more” for working with complex patients.
Hager was also of the opinion that the new measure would reduce existing administrative burdens and regulatory risks. In short, it appeared everybody would win -- patients because care is upgraded, hospitals because greater transparency will lead to greater assurance of releasing patients to a skilled nursing facility where they will receive top-notch care, and the facilities themselves because improved performance will lead to more referrals.
Nearly two years out, there are fears of unintended consequences. One study noted, for instance, the possibility of overreporting and overusing services early in a patient’s stay, leading to outsized reimbursements. There are also concerns about increased litigation, given the fact that skilled nursing facilities are now dealing with more complex patients. But in general, the reviews remain positive. The PDPM has done what it was supposed to do -- address what the above study called “perverse incentives” in the Medicare payment system.
The PDPM, while not perfect, represents a major step forward for U.S. healthcare, skilled nursing facilities in particular, and the patients they serve. And it really couldn’t have come along at a better time.
The Importance of Healthcare Staff Education (Especially During a Crisis)
By Bent Philipson | Wed Sep 30, 2020
Healthcare staff education can literally be a life-saver, but it’s an initiative that often gets far less attention than it deserves. Unfortunately, that lack of education is to the entire industry’s detriment: preventable medical errors are now a serious public health problem in the United States and contribute substantially to rising healthcare costs, among other issues.
Is it any wonder, really? Medical advancements, technologies and guidelines change at a rapid pace and can significantly alter the way care is provided. If healthcare workers are not in the loop and trained sufficiently, how can we expect them to adapt to a changing landscape and provide the most effective care?
The impact of COVID-19 over the last few months has made the importance of ongoing education abundantly clear. The crisis has completely upended the way healthcare workers have traditionally taken action to prevent themselves against the spread of disease. The National Institute of Health recently launched a website with critical educational resources in an effort to promote training programs to protect high-risk employees. With limited PPE available to healthcare workers, they’re learning to adjust with what’s available to them while still preserving their safety.
Hospitals and healthcare facilities across the world are having to take additional precautionary measures to ensure that staff and patients remain safe. Our network of skilled nursing facilities is no different; we’ve had to follow recommendations from the NY State Department of Health and the CDC and implement changes like requiring staff to wear facemasks at all times, asking our residents to remain in their rooms, and adjusting staff schedules to minimize the risk of exposure.
Every day is a balancing act for healthcare staff. Their performance, especially during a crisis, is heavily influenced by the structure of the organization’s internal staff education program. Everything from formal orientation to the maintenance of professional skills to their career development is directly tied to their success, but it’s also linked to the proficiency of the organization as a whole.
When you prioritize education, there are a number of payoffs you’ll see trickle throughout your entire operations. Here are a few of them.
A lower turnover rate
Employee retention is one of the biggest issues currently facing the healthcare sector, especially as we continue to feel the impacts of COVID-19. While the rest of the world is under quarantine, healthcare workers are still manning the frontlines of this pandemic. But underneath the calm, focused demeanor they put on while they’re at work, they are experiencing higher levels of depression and anxiety.
Working in healthcare is a tough job. That should go without saying, but it bears repeating. Rewarding though it may be, it’s easy to become burnt out, especially in today’s climate. Healthcare workers are working long hours and, just like their patients, they’re worried about their own health. Many have chosen to socially distance themselves from their family.
If you want to keep your employees, show them you care by investing in their professional development. Hiring competent people and paying them a competitive salary simply isn’t enough. You also need to show a sense of dedication to your company culture, staff retention programs, and of course, ongoing education. If your employees aren’t finding that at your organization, they may seek it out with one of your competitors.
Creating a positive environment
An organization that prioritizes ongoing education generates a positive, motivated, and energetic workforce. How you continue to mold your company culture during a pandemic looks a bit different, but it’s even more critical now — you just have to get creative.
Some facilities, when possible, are encouraging their staff to conduct more televisits. You have technology at your disposal, so are you taking full advantage? Train your employees on how to utilize videos and online chat tools to safely interact with patients. Employees want to feel empowered to do their jobs as best they can. That means training them on how to leverage what’s available to them so they can continue providing the best care to their patients while still complying with policies and safety protocols.
This isn’t only felt by staff, either; this translates to patients and residents as well. Compassion matters when it comes to the patient experience. By prioritizing your employees’ professional and personal development, you create an environment that’s welcoming, calming and cheerful. As a patient, wouldn’t you rather your medical provider have that kind of bedside manner instead of the alternative?
More efficient operations
You can’t have more efficient operations without proper training. If your training structure isn’t sound from day one, you already risk losing the talent you just hired. To return to the point about employee turnover for a moment, not having a good orientation program is cited as one of the top ten reasons why caregivers leave their agencies. Decreasing your turnover rate eliminates the rapid-fire cycle of hiring, acclimating, and training new employees.
If you’re an innovative facility that’s focused on serving as much of your community as possible, your staff needs to be equipped to handle the constant changes in regulations, policy, and technology. An organization in Boston, for example, started using artificial intelligence and set up a hotline where they could separate patients with less serious symptoms from the small subset of patients that are higher-risk. Of course, that implementation doesn’t happen on its own. Employees had to be trained on how to interact with the new AI software, as well as how to transfer patients to the correct virtual care center or hospital.
When people’s lives are on the line, staff education is no joke. Healthcare workers need to understand how to provide the best care to their patients, whether or not we’re in a crisis.
The challenges we face today with the global pandemic are more pressing than nearly anything else that has come before. The future is uncertain; the circumstances are complex and stressful. Your healthcare workers are brave and motivated enough to face these challenges daily and ensure that their communities stay healthy and strong. The least we can do is invest in their education and ensure that they have the tools and resources they need to face the future with certainty.
The Modern-Day Challenges Facing the CEOs of Healthcare Facilities
by Bent Philipson | Wed Sep 30 2020
Healthcare is one of the most rapidly evolving industries, and for good reason. While stagnancy within any other industry may curtail a company's competitive advantage, stagnancy within the healthcare sector can be life-changing. It compromises our ability to provide the highest level of care to patients in need.
In order to do right by our patients, the healthcare system must continue to evolve. And while this transformation is necessary, it also poses certain challenges to our existing infrastructure.
As such, CEOs of healthcare facilities often find the healthcare landscape a difficult one to navigate. For example, virtual care has completely transformed how doctors and patients communicate with one another. The COVID-19 pandemic has put telehealth capabilities to the test, proving all the more how digitized healthcare is revolutionizing the industry. But while all signs point to radical change, the U.S. healthcare system is impeding widespread adoption.
Throw in other age-old issues like talent acquisition, regulation changes, and increasing oversight and it's clear that healthcare leaders face immense pressure influencing change in such a dynamic field. Implementing effective solutions is only possible when leaders fully understand these challenges and how they could impact their organizations.
Staying on top of technological advancements
Emerging technology is critical to the betterment of our healthcare system. It's not only the most effective solution for better care, but it also lessens the impact healthcare organizations and patients feel when there are complications within the industry.
The Association of American Medical Colleges (AAMC) predicts that the U.S. will experience a shortage of 122,000 physicians by 2032. COVID-19 is only worsening the impact of this shortage as doctors, nurses, and other healthcare staff who become sick are having to be pulled from their workstations. The larger reason for the shortage isn't because professionals are leaving their positions, though -- it's because the population continues to age at an alarming rate. To account for people living longer lives and making sure everyone has equal access to healthcare, it's currently estimated that the United States would need an additional 95,900 doctors and nurses.
But that's not going to happen overnight, or even within the next decade. This is where we see technology's biggest benefits. As healthcare organizations face staff shortages, virtual care options help pick up some of that slack. Telehealth consultations reduce wait times by 20 percent and allow professionals to more easily treat common health conditions and manage chronic illnesses that require more frequent touchpoints.
Telehealth's benefits are undeniable, so why aren't we seeing it everywhere? Sometimes knowing something is good isn't enough to set it in motion. Healthcare leaders must introduce virtual care into their existing workflow in a way that feels effortless, they must understand how it fits into their bigger organizational goals, and then they must incite user adoption, which is especially difficult to do with older generations.
Cybersecurity concerns
You can't talk about technology without talking about privacy and security. One of my biggest undertakings as CEO of a New York nursing home has been converting our organization to the cloud. Cloud adoption is a no-brainer, but data security and HIPAA compliance concerns are a real threat.
In 2018, over 471 million patient records in the United States were exposed by cyberattacks. Cloud technology is meant to enhance patient care, but when patient information is compromised, it can have dire consequences. Just a few years ago, healthcare organizations were exposed to the worst cybersecurity attack in history.
The attack happened after a cyber gang called Shadow Brokers released ransomware called WannaCry and wreaked havoc across the world. More than 20 healthcare organizations were affected; in some instances, doctors and nurses even had to turn patients away and cancel life-saving surgeries. And there are countless examples like this.
The healthcare industry holds some of the most sensitive information available, yet it fails to adequately address information security. When asked about their cybersecurity efforts, over 81 percent of healthcare executives have reported that their organizations experienced some level of attack within the last few years. This hasn't only proven costly for the healthcare system, but it puts patients lives at risk.
Shifting from volume to value-based care
The healthcare industry is finally recognizing the need to move from volume to value-based care. Fee-for-service has been commonplace for so long, but we're seeing more organizations start to implement fee-for-value structures instead.
In volume-based care, a successful system is measured by high-profit margins not the quality of care. The opposite is true in value-based care, which takes a holistic view of patient health and services. Because healthcare executives have the best interest of their patients in mind, they work to connect their department initiatives and their ongoing staff education to match that end goal.
Value-based care is the solution to what is wrong with our current healthcare system. It reduces healthcare costs, particularly for those with chronic health conditions, which are influenced by patient outcomes. It also leads to healthier populations. In a world where half the population doesn't have access to essential, life-saving services and 13 percent of Americans — or around 34 million people — know one person who has died from not being able to afford critical medical attention, value-based care is the answer.
Yet, most monumental change comes with hurdles blocking widespread adoption. Some healthcare CEOs lack the operational wherewithal to implement these initiatives. Value-based care also requires specific technology in order to be successful. Going back to the struggles some healthcare leaders have with technological inclusion, this often becomes another setback.
We are at the forefront of systematic change. For healthcare executives, riding this sea of change is difficult, but we must. As we move forward, we need to question and challenge the outdated and traditional processes, resources, and procedures that were once revered in the past. There will be hurdles to face every day, but when your focus is on your patients and staff, overcoming these barriers is worth it for the healthcare industry’s future, and theirs.
How Technology Has Senior Care Soaring Into the Cloud
Imagine that you're an elderly diabetic patient in your early 80s. Today you're having a routine checkup with your doctor just to make sure everything is in tip-top shape. But instead of going to a doctor’s office, you simply log on to your computer for a brief consultation.
With just a few clicks, your doctor uploads all the data from your wearable device so they can take a look at your blood glucose levels and vital signs. Your appointment is over in a matter of minutes. You didn't have to find transportation to the doctor's office, nor did you have to schedule your entire day around the appointment. In fact, all you had to do was open your computer for a routine checkup.
This may sound like a futuristic scene out of a sci-fi movie, but cloud-based technology has made this a present-day reality for seniors.
The senior care industry has historically been slow to adopt technological advancements such as cloud solutions for a number of reasons, not the least of which concerns data security and HIPAA compliance. To make matters more complicated, a high volume of patient information would need to be converted to the cloud, and we’d be asking significant behavioral changes of a generation not particularly well-known for its technological proficiency.
But an increased fervor in cloud adoption couldn't have come at a better time. With COVID-19 affecting seniors more than any other age group, telehealth has become a prudent alternative for certain in-person doctor visits. Medicare recently expanded their coverage for telemedicine to ensure that seniors are still getting the medical attention they need, while also keeping them safe from avoidable exposure.
Beyond the current pandemic, ten thousand people are also set to turn 65 every day for the next 20 years in the United States alone. Longer lifespans mean an increased need for medical care. One in five boomers have already been diagnosed with diabetes. Over half of their generation has been prescribed pills to lessen the effects of hypertension, which is all the more important because 40 percent of boomers are considered obese. And this list is just the tip of the health-issues iceberg. It's projected that by 2030, 60 percent of the generation will be managing more than one chronic health condition.
Caring for an increasingly aging population will continue to put a strain on senior care unless we embrace new solutions that account for these demographic shifts. Thankfully, that shift is well underway.
Technology isn't just a young person's game anymore. An increasing number of seniors now own smartphones and various smart devices. Over 17 percent have even started using wearable devices in their everyday lives. Younger generations may covet wearables to track their fitness and weight loss journeys, but the advantages extend far beyond counting calories.
Smart devices can now measure a person's heart rate, blood pressure, body temperature, and oxygen levels. One new gadget can even analyze blood sugar levels without an incision. Others can detect falls in real-time and will send an alert to a call center that will immediately dispatch emergency services to the person's home.
Wearables give seniors peace of mind knowing they're protected if their health would take an abrupt turn for the worse. Gone are the days of countless tests to pinpoint what's causing the health issue, and weeks of having to wait for those test results to come back. With wearables, a physician or nurse can remotely monitor a patient’s vitals from afar, alleviating the strain on the senior care system and minimizing unnecessary, routine appointments.
Many seniors worry that remote checkups won't allow for the same quality of care, but the evidence indicates otherwise. A recent study shows that telemedicine results in 38 percent fewer hospital admissions, 31 percent fewer readmissions and over 60 percent of people spend fewer consecutive days in the hospital.
Remote monitoring can also help seniors take control of their own health on a more regular basis. Say someone suffers from a severe heart condition, for example. By monitoring their vitals, a patient’s wearable device can incentivize them to stay away from salty snacks that could have dire consequences. These technologies are so advanced they can even signal whether a heart palpitation is being caused by indigestion or is a sign of something more serious.
It's common for seniors to live more sedentary lifestyles, especially those that struggle with physical ailments or other chronic health conditions. But we know that sedentary lifestyles worsen the majority of health issues, which is why an age and health-appropriate exercise regimen is so important for longevity and stamina. Just as wearables can monitor medical conditions, they can also keep seniors on track with their health and activity levels, providing a much-needed breath of independence.
While cloud technology’s advantages are significant, they are not without challenges. While the U.S. Department of Health & Human Services temporarily loosened HIPAA restrictions to allow greater access to telehealth during the COVID-19 outbreak, it is unclear to what extent that will remain so afterward. Similar uncertainties surround Medicare’s expanded telemedicine coverage.
Also of particular importance is ongoing staff education. In order to provide the best care to patients, nurses and physicians need access to updated policies, procedures, and resources that inform care and treatment options. Thankfully, the cloud also makes staff education easier, serving as a one-stop database for guidelines and changes in treatment, technology, and protocols.
Cloud technology allows healthcare facilities to achieve the holy grail of senior care: it's cost-effective, it allows for operational efficiency, and it encourages better outcomes through patient independence. It is not a replacement for face-to-face care, but it does provide much-needed support to a heavily strained system. The level of care we provide to residents and patients only goes as far as the innovations we choose to enmesh within our operations. If we don't take cloud technologies seriously, we only hurt those we claim to serve.
Embracing Diversity Will Secure Innovation and Profitability
by Bent Philipson | Wed Sep 30 2020
There is no shortage of advice when it comes to helping companies become more innovative. Innovation is what breaks the constraints of outdated methods and can transform entire industries. The problem is that a majority of these opinions are anecdotal and what works for one organization might not work for another, especially if you are crossing over industries.
But there is one piece of advice that is rooted in facts. Diversity in an organization's leadership will engender innovation and drive better financial performance. Now, this isn't breaking news. A 2016 report found that a more diverse representation in senior management will lead to greater profits. In 2018, another study confirmed the same findings. And so on.
This is huge for startups and tech companies that rely on innovation to maintain a competitive advantage in their industries, but it's even more persuasive for healthcare organizations. Despite efforts to drive progress, healthcare has remained at the edge of radical innovation. Innovation must become a priority where it's not already to reduce spending and improve patient care.
Healthcare executives that start making small adjustments to the makeup of their senior teams now will soon experience accelerated results.
Diversity as a business practice, not just a metric
There's never one way to solve a problem. We know this from our own experience in the workplace, even if we don't come from all-inclusive organizations. But as Katherine Phillips, a Columbia Business School Professor, writes: "Diversity jolts us into cognitive action in ways that homogeneity simply does not."
Our ingenuity and unique approach to problem-solving is influenced by who we are and where we're from. If the people around the leadership table all look and think like you, it's more likely to spur complacency and uniformity in thought, which is the enemy of innovation.
Differences in leadership is like a melting pot of ideas and perspectives. Sharing these viewpoints forces others to consider opinions unlike their own. As such, preparing and communicating these points demands a deliberate, methodical approach that will feel like more effort, but will prove invaluable over time.
When leaders are accustomed to diversity, they are able to recognize new opportunities to support untapped markets and unmet needs. In an industry like healthcare that is constantly evolving and toeing the line of change, this level of adaptability is what innovation requires.
We talk about the future-forward impacts of diversity, yet what does a diverse leadership team really look like? In healthcare, this is a critical concept to consider because it doesn't only impact business success, but also patient outcomes.
Healthcare executives must reflect the patients they serve
Traditionally, the umbrella of diversity included people of different genders, races, and ethnicities. According to one study, companies in the top quartile for gender diversity were 21 percent more likely to experience above-average profitability. The same study also found that ethnic and culturally diverse teams were 33 percent more profitable than homogenous teams.
While profound, diversity now contains a much larger spectrum, including lifestyle choices, sexual orientation, experience, and social determinants of health. Organizations that include representation from all of these areas are 45 percent more likely to report a growth in market share than other facilities.
But we have a long way to go. Research has found that minorities represent around 32 percent of hospital patients, while only 14 percent of hospital board members and 11 percent of healthcare executives. This data is similar to a 2013 survey conducted by the American Hospital Association's Institute for Diversity, which is alarming.
A healthcare organization can't fully understand the needs of its patients, nor can it influence the necessary change to improve care and treatment for these demographics, unless members of the leadership team reflect the patients they serve. The healthcare industry demands inclusivity, and a diverse management team gives a voice to those whose lives are in jeopardy if the change is not enacted.
This is even more compelling in the midst of a global pandemic as communities everywhere are being hit hard by the coronavirus. It's been proven that pro-diverse facilities have been able to successfully weather the storm of past recessions, not only because of their stronger business solutions but because they're better able to make patient care the center of their focus.
The healthcare industry is crying out for real, equitable change. This is only possible when healthcare executives take the initiative to prioritize diversity in their leadership teams. While innovation is necessary for better patient outcomes, it also improves profitability and increased performance for organizations themselves. It's a win-win-win.