HA510 Unit 4 Discussion Opinion

In two different paragraph Give your personal opinion to

Treasury Williams and Heather Schlegelmilch 

Heather Schlegelmilch 

As an administrator in a skilled nursing facility the two internal factors that I would be concerned about daily is staffing and census. External factors of concern would be the Patient Driven Payment Model (PDPM), that went into effect October 1, 2019, and the competitive market that my facility is in. All these factors contribute to the success of my campus.

The Centers for Medicare and Medicaid Services (CMS) focuses on staffing and the correlation between staffing and quality of care (CMS.gov). CMS collects data from every skilled nursing facility regarding their staffing through Data Submission Payroll Based Journal (PBJ)  and provides that data on their website and it factors in calculating the facilities Medicare Star Rating which is an important quality rating that can prevent a facility from participating in hospital ACOs, insurance contracts and other partnerships if the facility has a low start rating. The rating can affect census as well since this information is made readily available for families looking for rehab and long-term placement of their loved one.

A Senior Housing CEO has said in numerous communications with Executive Directors that “it all starts with census” and there hasn’t been a truer statement. As an administrator the budget is my responsibility so reaching and maintaining my budgeted census is crucial if I’m going to be in the black on my P&L. Being at my budgeted census or above means hours remain the same, maybe even increased if running above and money is being made. Fall below budgeted census and I must cut staffing. What happens to my staffing then? My team worked hard to fill all open positions and now because of low census those nurses and aides that were hired with an expectation on being full-time are now going home early and losing out on income (Kennedy, 2019). So, they quit, and census goes back up but now I’m understaffed and can’t hire and train quick enough to catch up to my growing census, so my clinical team is now working over and I’m paying out a lot of overtime. They are working short which leads to burnout and they may leave as well. Keeping census is key to keeping staffing stable.

Then there’s the external factors that I must be concerned with and the frontrunner currently is PDPM which is a complete overhaul of the Medicare payment system which is replacing the current fee-for-service RUG payment system. The last change in reimbursement was back in the 90’s so shifting focus to PDPM has taking countless amounts of training. In a nutshell, a resident’s stay was primarily determined by therapy and we were paid based from therapy hours now we’re being paid based on the patient’s diagnosis and care needs (Spanko, 2019).

“Since therapy no longer driving the reimbursement bus, nurses will once again return to the quarterback role they had previously held in in the SNF environment” (Spanko, 2019). What I’m concerned about now is the acuity of the patients we admit, previous we liked to take less clinically complex patients like orthopedics that required lots of therapy hours. Now I’ll get paid more on those complex patients with multiple comorbidities, so I had to have my clinical team trained for more complex patients. Documentation and MDS is key and they need as much clinical background information on all patients admitting quickly to increase my reimbursement, so I have to continue to monitor my admissions team and MDS to ensure they are getting all the documentation needed from the hospital prior to admission.

In addition to PDPM I worry about my competitive market. There are many alternatives then going to a SNF. Home Health, Hospice Centers and Assisted Livings are all taking a piece of the market share. In addition, orthopedic patients are being admitted home with home health and bypassing the SNF all together (Levins, 2017).

Even with all the internal and external factors that can impact the success of my facility there is one factor that will play in my favor as long as I continue to provide quality care and that is the unprecedented growth in the senior population according to the American Healthcare Association. There will be an Increase in demand for skilled nursing and assisted living services due to this increase.

References:

Kennedy, S. (2010). ‘Go Home, Stay, Good Nurse’: Hospital Staffing Practices Suck the Life Out of Nurses. American Journal of Nursing. Retrieved November 2019 from, https://ajnoffthecharts.com/go-home-stay-good-nurse-hospital-staffing-practices-suck-the-life-out-of-nurses/

Levins, H. (2017). U.S. Nursing Homes Struggle in Ever-Tougher Market. National Summit at PennLDI Catalogs Industry's Economic and Policy Issues. Retrieved November 2019 from, https://ldi.upenn.edu/news/us-nursing-homes-struggle-ever-tougher-market

Spanko, A. (2019). PDPM 101: What Skilled Nursing Providers Need to Know Now. Skilled Nursing News. Retrieved November 2019 from, https://skillednursingnews.com/2019/03/pdpm-101-what-skilled-nursing-providers-need-to-know-now/

Treasury Williams

Internal and external factors have a huge effect on the success or failure of a business. Although the Business owners can’t control external factors, they must still be able to anticipate and adjust to these factors to keep their organizations on track.

Two internal factors that has an impact on the operations of health organizations would be leadership and employees. I chose leadership because Leadership is considered as the people inside of an organization who usually make all the major decisions. Leader who are unable to properly lead their team will find it difficult to achieve the goals of the organization do their jobs. Without the proper leader it is hard for an employee to do their jobs which mean if the employees are unable to do their jobs the organization will fail.

The two outside factors that has an impact on the operations of a health organization would be the economy and the competitors of the organization. The economy plays a big role in any healthcare business. If the patients are struggling financially it will be very difficult for them to afford insurance or any healthcare treatment. When it comes to competitors of an organization every business owner does thing differently, but if one owner tends their business better than the patients or clientele will tend to migrate where they feel more welcome and satisfied.

Quain, Sampson. “Internal & External Factors That Affect an Organization.” Your Business, 4 May 2018, yourbusiness.azcentral.com/internal-external-factors-affect-organization-11641.html.