Green House Blog

CMS Five-Star Rating Program Update

The President and CEO of The American Health Care Association (AHCA), Mark Parkinson, recently released a statement to AHCA members regarding President Obama’s Executive Action on October 6th to improve the Five-Star Rating Program.

As a result of the President’s Executive Action, the Five-Star Program, created by CMS six years ago, will change in two key ways. First, payroll data will be collected in order to improve accuracy of staffing information. Second, the administration has developed three new quality measures that will be added to the nine existing measures: rehospitalizations, discharge back to community and antipsychotic use.

According to Parkinson, “As CMS changes the staffing and quality measures, it will need to create new scoring and therefore, new cut points. This inevitably will impact the staffing scores and quality measure scores for a significant number of providers.”  In light of this, AHCA has issued a collective call to action in order to educate providers, legislators and CMS about the potential problems that may result from the Executive Action.

To learn more about the history of the program and AHCA’s call to action, read the full statement here.

Reflections from the Director: Changing Times / Changing Measures / Changing Behavior

Changing performance metrics can catalyze a dramatic improvement. I recall the story of Walgreens in the book “Good to Great” by Jim Collins. Collins and his research team describe Walgreens as nothing more than a sleepy retail pharmacy chain that limped along for years before a dramatic rise to great results that lasted for over 15 years. The researchers examined what triggered the change and discovered that Walgreens had deviated from the industry norm of measuring their performance. All retail pharmacies, including Walgreens before their rise to greatness, had used one key performance metric to measure their performance – revenue per square foot per store. When Walgreens began measuring their own performance with a new measure – revenue per customer visit – their dramatic acceleration began. Gradually, all other retail pharmacies followed suit and began to use this new performance metric and it changed the retail pharmacy industry forever. The change in this one performance metric led to new systems, improved staffing and re-designed stores. In fact, when Walgreens reset their measure they set a new goal. The goal was $40 per customer visit. My wife consistently exceeds that goal.

In the Skilled Nursing profession, for over 45 years, we have all measured our performance by, generally, a single measure – our annual department of health inspection results. Recently, my Dad shared with me a newspaper article that described 5-Star nursing home closing its’ doors in Massachusetts and the article kind of shook me up. After all, the whole intent of the 5-Star rating system is to drive consumers to the best performing SNFs. So…why do 5-Star homes close and 1-Star homes remain full? Perhaps the 1-star home is actually a better performer than the 5-star home. The answer lies outside of our one key performance measure.

The metrics of SNFs are shifting – and this bodes well for the profession as a whole. Two performance measures are taking hold that will surely help to separate the star performers from the rest of the pack. The two we are speaking of have been hammered away at the nursing home professionals nationwide – reduce or eliminate the off-label use of antipsychotics and reduce the avoidable re-hospitalizations. Just like Walgreens, the improvements in these two measures will require improving the systems of care, enhanced staff composition and competence, and changing the physical environment of SNFs.

Reducing or eliminating the off-label use of anti-psychotics triggers providers to get serious about delivering person-centered care. Organizations will need to reduce their C.N.A. to resident ratios and de-institutionalize their physical environments (and we are not talking about simply new wallpaper). Enhancing the competence of the entire staff through a significant increase in education hours that are focused on caring for those living with dementia will be foundational to their success.

Reducing re-hospitalization rates leads SNF leader’s to raise the bar on increasing clinical competence and adding talented and compassionate RNs to their staff. Also, this new measure forces leaders’ to re-examine their turnover rates and absenteeism because staff instability does not allow for consistent assignment and diminishes communication. Clearly, the health of the relationships among the staff of each SNF is reflected in their re-hospitalization rate. Therefore, better systems of communication and new job descriptions are needed to strengthen staff relationships. Today, many providers can see that their current physical environment – an average of 85 elders living together in tight quarters, shared rooms, shared bathrooms, shared shower rooms – is perfectly designed to spread infections among the elders and staff. Private rooms with private baths and showers for each elder will become the new norm. A smaller and better designed environment is critical to both clinical outcomes and a dignified quality of life.

Of course, a SNF’s performance on their annual department of health inspections is important and always will be. It has to remain a key measure with the other 5-Star metrics. Examined next to a SNF’s performance on these two measures will provide consumers, operators, surveyors and policy makers a way to more clearly identify where elders should flock to for their care.

Notes from The Green House Director: Achieving the Triple Aim of Long Term Care: Quality, Health, Affordability

Recently, I was honored to speak at the Michigan LANE (Local Area Network for Excellence) conference in East Lansing that was attended by close to 300 dedicated leaders of skilled nursing facilities.  It was there that I was reminded of the Centers for Medicare and Medicaid Services (CMS) Triple Aim –

1.) Improve the persons’ experience of care – both quality and satisfaction

2.) Improve the health of people and the community’s health

3.) Reduce the cost and wasteful spending

I feel confident that The Green House Model addresses all three of these goals.  And we have a significant amount of independent research to support this feeling.   Thanks to the support of The Robert Wood Johnson Foundation, The Weinberg Foundation and AARP, model is spreading and Green Houses nationwide have the outcomes that hit these marks and outpace traditional SNF’s.

After the LANE event, I stayed in Michigan and I saw an excellent example of how visionary leaders in Michigan collaborated in order to hit the CMS Triple Aim while helping to revitalize downtown Detroit.  I had the opportunity to tour the new Rivertown Neighborhood, an affordable senior community that will provide over 770 seniors access to desperately needed housing and supportive services.   The grand opening is April 12th.

Presbyterian Villages of Michigan (PVM), in collaboration with Henry Ford Health System and United Methodist Retirement Communities, have creatively adapted an old dilapidated pharmacy plant and expanded The Center for Senior Independence (CSI) program (nationally recognized as PACE).  Two Green Houses serving 20 – 24 elders will be an integral part of the Rivertown Neighborhood.

At the end of the tour, Roger Myers, the President and CEO of PVM, and his incredible team of partners, brought us into bottom floor of a cold, open space of a four-story brick building attached to the beautifully renovated building.   None of the floors were in the building so that you could look up to the ceiling that was 4 stories up.  This is where a huge vat of cough syrup used to brew and this is where the two Green Houses will sit on two floors above a café.

The Rivertown Neighborhood demonstrates how we can tackle complex social factors that effect elders’ heath and their well-being.   Over 200 employees (and Shahbazim) at Rivertown will address the social determinants of health, and the healthcare, of hundreds of the community’s seniors every day.  In so doing, they will give peace-of-mind to thousands of the elders’ family and friends.   Its’ an exciting project and am thrilled the Green House Project is a part of it.

 

 

Collaborating for a “Sustainable” Future

The future demands that we work together to create viable and sustainable programs.  The world is a dynamic and ever-changing place, with an imperative to do more with less.  In order to achieve these outcomes, the charge is there to innovate and collaborate—pooling our resources and strengths, to evolve our communities. 

Recently, in New Orleans, The Green House Project team had two different opportunities to interact with thought leaders who are impacting the future.  First, we participated in  a round table discussion with Strategic Development Partners, where we joined a diverse group from healthcare, education and finance to contemplate the vision for sustainable, livable communities.  Next, during the AHCA-NCAL Independent Owners conference, the focus on quality as an economic imperative, sparked many substantive conversations about the role The Green House Project can play in long term care innovation.

 The concept of sustainable development was a continuing theme throughout the week,  but what does “sustainable” mean in this context?  The United Nations 2005 World Summit Outcome Document refers to the “interdependent and mutually reinforcing pillars” of sustainable development as economic development, social development, and environmental protection. By investing in local culture and shifting thinking from “who are you building it for“, to “who are you building it with”, the potential is there to create value and a perpetuating impact for the community.

Through an initiative on quality, AHCA CEO, Mark Parkinson, imparted that to survive in this changing health care environment, providers need to diversify and adapt.  Sustainability is multi-fold, in order to be financially viable, the organization must have a keen focus on quality.  Parkinson said, “Quality is not just the right thing to do, it is an imperative to survive and be reimbursed in the future”.  AHCA is focusing on hospital readmissions, anti-psychotic drugs, staff retention and resident satisfaction as benchmarks to determine quality.    

The time in New Orleans, taught The Green House Project team many lessons about sustainability.  To survive and thrive, there must be a focus on the social, financial and environmental impact of innovation.  Ongoing benchmarking and data collection is necessary to ensure that there is an evidence base for the good work that is being done, and that our resources are being used effectively.  Most importantly, sustainable development requires participative discussion, and inclusion of many different stakeholders.  By bringing those “interdependent and mutually reinforcing pillars” to the table, the end product has the power to create that integrated force for success!

Collaborating for a "Sustainable" Future

The future demands that we work together to create viable and sustainable programs.  The world is a dynamic and ever-changing place, with an imperative to do more with less.  In order to achieve these outcomes, the charge is there to innovate and collaborate—pooling our resources and strengths, to evolve our communities. 

Recently, in New Orleans, The Green House Project team had two different opportunities to interact with thought leaders who are impacting the future.  First, we participated in  a round table discussion with Strategic Development Partners, where we joined a diverse group from healthcare, education and finance to contemplate the vision for sustainable, livable communities.  Next, during the AHCA-NCAL Independent Owners conference, the focus on quality as an economic imperative, sparked many substantive conversations about the role The Green House Project can play in long term care innovation.

 The concept of sustainable development was a continuing theme throughout the week,  but what does “sustainable” mean in this context?  The United Nations 2005 World Summit Outcome Document refers to the “interdependent and mutually reinforcing pillars” of sustainable development as economic development, social development, and environmental protection. By investing in local culture and shifting thinking from “who are you building it for“, to “who are you building it with”, the potential is there to create value and a perpetuating impact for the community.

Through an initiative on quality, AHCA CEO, Mark Parkinson, imparted that to survive in this changing health care environment, providers need to diversify and adapt.  Sustainability is multi-fold, in order to be financially viable, the organization must have a keen focus on quality.  Parkinson said, “Quality is not just the right thing to do, it is an imperative to survive and be reimbursed in the future”.  AHCA is focusing on hospital readmissions, anti-psychotic drugs, staff retention and resident satisfaction as benchmarks to determine quality.    

The time in New Orleans, taught The Green House Project team many lessons about sustainability.  To survive and thrive, there must be a focus on the social, financial and environmental impact of innovation.  Ongoing benchmarking and data collection is necessary to ensure that there is an evidence base for the good work that is being done, and that our resources are being used effectively.  Most importantly, sustainable development requires participative discussion, and inclusion of many different stakeholders.  By bringing those “interdependent and mutually reinforcing pillars” to the table, the end product has the power to create that integrated force for success!