CCRC's, SNF's, and Elephants

I presented a keynote recently, at the Revenue Summit of the Maun-Lemke Group's clients, where I discussed the service-revenue imperative with a group of administrators from continuing care retirement communities (CCRC's) and skilled nursing facilites (SNF's) from across the US.  The presentation highlighted the need for this vital sector of the healthcare profession to start taking seriously, the provisions in the PPAAC bill related to CAHPS.

I stressed the importance of CAHPS as a lever to improve not only operations but also service and revenue, and gave a dozen or so cases where the administrators could act immediately (at little or no cost).  We discussed the reality of ACO's as an incentive to improve service quality, then moved on to the very real experiences of the hospital sector with HCAHPS.

I told the story of how HCAHPS evolved from 'something I'd read about once or twice' (where the mindset of most in the room sat), to the current reality of Value-Based Purchasing and the reductions in DRG reimbursements to every hospital.

"You think this isn't your future too?"

We then moved on to some practical tips on how to manage resident satisfaction proactively.  I'm sure that you know the answer to the old riddle about how to eat an elephant - one bite at a time.  Funny how the simple wisdom of childhood riddles can help us attack real-world problems sometimes - or at least get a perspective on them.

The 'eat an elephant' strategy can help a hospital, CCRC, or SNF improve HCAHPS or CAHPS scores:

• using your survey vendor's data, find the highest volume unit


• find scores by unit (if available)


• develop an elasticity table in Excel (if not provided by your vendor)...if you improved the mean on (say) Unit1 by 1 point, what impact would it have on the entire hospital?


• focus on the highest-volume units


• get staff and leader input...which dimension of HCAHPS/CAHPS should we target first, that will give us the biggest payoff (eg: Communication re Meds, or Quiet at Night?)


• which one does staff feel that they can most easily affect, based on their current training, resources, process improvements, and staffing levels?


• what additional resources will be required, and can these be reasonably provided?


• what are the likely root causes?


• can the root causes be removed quickly and efficiently?


• how sustainable will the outcomes be?


• what type of interim measurement process can we bring to bear, to assure daily forward momentum?


• are there any staffing issues that are affecting our current performance (eg chronic shortages, etc)

These are just some questions to challenge you to focus and act!

BL

Good, bad, and surprising news regarding VBP.

By now, most people are aware of the Value-Based Purchasing provisions in the Patient Protection and Affordability Act that was signed into law last March.

The good news is that there will be financial incentives for improvement of HCAHPS scores (achievement or attainment).

The bad news is that there's no new money to pay for the incentives.

Through a somewhat complex model, most hospitals will see their base DRG reduced by 1% on October 1, 2012, to fund the incentive payments described in the legislation. This amount will increase in 2014 to 1.25%, 2015 to 1.5%, etc.

Now here's the surprise to many people: while the incentive payments begin (funded by the base DRG reductions ) in 2012, they'll actually be paying the incentives for HCAHPS performance earned in 2011.

This means that effective Oct 1, 2011, your HCAHPS scores will actually start to 'mean something', as the baseline measurement period begins. So, in less than 13 months, the HCAHPS clock really begins ticking.

It'll be more important than ever to have a coherent strategy to manage the patient experience through the involvement of every frontline associate in your building.

My challenge - questions today are:

1. How effective is your current strategy at really improving your HCAHPS scores through enhancing the patient experience?
2. Do your frontline caregivers 'own HCAHPS'?
3. Who is the executive responsible for championing changes and initiating performance improvement?
4. Where do you stand relative to your competitors - have you done a gap-analysis?
5. Have you assessed the dollars at stake for your hospital under VBP?

'Communication' for really, really busy managers.

Every manager knows that communication is central to her/his job. We're taught it in B-school, and it was drilled into us way-back when we were still wet behind the ears.

What they didn't tell us was what the impact of good communication would be.

Did you know though, that a management team that is (uniformly) a group of great communicators links to a 29.5% market value premium of their company? Or, that companies with better organizational communicationl earned shareholder value 50% better than industry peers.

Watson Wyatt, in an '06 report, goes so far to say that communication is a central key to employee engagement, itself a leading indicator of market value.

Yet rotten communication persists.

We see it when branch offices are 'out of the loop' for months on corporate initiatives, or one or more departments are apparently marching to their own drummer when it comes to service, safety, or other items of strategic importance.

It's so common, that as consumers, we've become agile enough (or is it just patient enough?) to navigate around many company's service policies just to complete basic transactions (such as servicing our cars).

As managers, we can improve the communication in our organization, by:

• Recognizing the critical nature of communication to the bottom line, and personally committing to improving our skills, discipline, and focus in this area
• Position company communications to our employees through the filters of what they're interested in hearing:

- provide a clear line of sight to your company's strategy, so that your employees know how their work affects the 'big picture' and how the big picture affects their work

- provide knowledge so that your employees can affect their performance within this context

- provide recognition, guidance, and accountability, so that your employees know that their effort matters

Comments?