Healthcare Questions

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Pleasant Manor Scenario

Pleasant Manor (PM) is a 250-bed Skilled Nursing and Sub Acute Rehab facility (SNF) located at Vero Beach, Florida, a midsized community with roughly 75,000 people and higher- than-average retirement population. Built in the early 1980s and founded by two local businessmen, PM was a leader in quality care, providing long-term skilled nursing care mainly for the elderly. In the late 1980s and early 1990s, the SNF industry began to change with the emergence of sub-acute care and growing elderly population. By the mid-1990s, a sub-acute boom had taken over the health care industry. Many SNFs were converting beds to sub-acute care and rehab had become a very profitable business. A fee-for-service Medicare Model fueled this boom. PM quickly adapted to these changes; in 1991, it converted 50 beds from long-term care to sub-acute and in 1993, they converted another 50 beds. By 1994, their sub- acute census was steady above 90% and they were known in the area as a leader in both rehab and skilled nursing.

PM invested in facility upgrades in 1995, adding to their rehab wing state-of-the-art

rehab room, which included a physical therapy gym, private activities for daily living (ADL) room for occupational therapy including a kitchen, and separate treatment room for speech therapy. The wing also implemented restorative dining, memory, and nutrition programs. PM’s sub-acute wing’s primary focus was physical therapy (PT), occupational therapy (OT), and some speech-language pathology (SLP). The facility had one rehab director, three full-time physical therapists, four physical therapy assistants, two occupational therapists and two occupational therapy assistants, and one full-time and one part-time speech language pathologists. It also began to capitalize off Part B Medicare rehab, from already existing long- term care residents. In 1995, the occupational therapy department started an ADL program to help current residents improve their ADL ability and the physical therapy department began working on a Wheel Chair Positioning Program. Both programs allowed for the rehabilitation department, assessing current residents and billing Medicare Part B for needed treatment. This contributed to continued growth. As far as competition was concerned, several facilities in the area also benefited from changes to sub-acute. However, PM remained the leader.

However, by the late 1990s, changes to Medicare, mainly capitations on Part B and prospective payment system, changed the landscape. Rehab revenues began to decline and PM’s minimum data set and billing departments struggled to adapt to the New Medicare Billing System (RUGS). Slowly, PM began scaling back on rehab. As revenues slowed, PM fell behind on updating equipment and the management team lacked ideas and drive to create new and innovative programs. PM also began to lose market share each year from 2000 to 2007.

In 2007, the PM owners were reaching retirement age and sold the facility to a small

but an upcoming health care company called Innovative Health Care Solutions (IHCS). IHCS is owned by a group of private investors. IHCS is known for buying troubled facilities, mainly SNFs, and turning them around.

From 2007 to 2009, IHCS began investing in and upgrading PM. By the end of 2009,

PM’s overhaul was completed. A new administrator was brought and much of the therapy team and nursing management had been replaced.

Facilities were upgraded, but more importantly, new programs to help increase census were implemented. PM now offers the following programs and services:

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Pleasant Manor Scenario

1. Alzheimer’s wing.

2. Memory center and Dementia program.

3. Wound care.

4. IV therapy.

5. Upgraded and modern PT, OT, and SLP programs.

6. A specialized 10-bed hospice wing and hospice services.

7. An upgraded dining room and dining experience for all residents.

8. Outpatient therapy programs.

9. Contracts with local providers to provide podiatry, dental, and eye care services.

10. Activities program with a new creative and age-appropriate approach.

Along with the services, the philosophy of the facility has changed to a more resident- focused approach. A quality assurance team comprised of current staff has been assembled and strict monitoring of patient care and resident satisfaction is taking place. A resident counsel for long-term residents has been established and resident feedback is highly encouraged.

With all the positive changes and investment in new programs, the IHCS board would live

to see faster improvements in the average weekly census and a higher rate of referrals to the facility. It has charged you with developing a marketing plan to help promote the facility to both the community and providers who are most likely to refer residents or rehab patients.

Your group will now develop a marketing plan to promote PM and its new programs and

services as well as new resident focused philosophy.