From Chronic Underfunding to Inflation to Staffing and More…
The overriding focus guiding all SALMON Health and Retirement facilities is the quality of care they provide. SALMON’s commitment to building, maintaining and ensuring quality never wavers. But achieving the industry’s highest quality is complicated and gets more challenging every year.
“The chronic underfunding of long-term care combined with the inflationary environment for staffing and costs have made it increasingly difficult for our industry to profitably provide high quality care based on what Medicare and Medicaid pay our facilities,” said Andrew Salmon, Executive Director and Chief Future Officer for the family-owned company that his grandparents founded in 1952. “This, combined with issues ranging from the COVID-19 pandemic to inflation, staffing challenges and more has made it necessary for us to very closely control our clinical and business operations.”
One hallmark of SALMON over its more than 60 years in operations is evolving to meet change. As these challenges became more pronounced, Salmon began looking for tools that could help manage four operational areas he identified as crucial for a SNF/LTC to survive:
- Monitoring and keeping hospital readmissions low,
- Preparing survey and achieving the Five-Star ratings,
- Managing staffing-related issues and needs, and
- Setting optimal census numbers and using quality data to increase their census through hospital referrals.
About 10 years ago, SALMON adopted PointRight, now a Net Health company. PointRight’s analytic solutions help SNFs achieve better outcomes, mitigate risk, ensure compliance and optimize reimbursement during rapid and profound changes in the industry. In PointRight’s solutions, Salmon not only found a tool that could address each of those four operational areas, but also one that offers a solution for virtually every task and problem facing the industry. He says:
“PointRight is the only tool I’ve come across that is universally accepted by the operations, finance, and clinical teams. Everyone trusts and believes in their data.”
Salmon believes that the key to survival in today’s marketplace is an effective, efficient, and high-quality tool like PointRight, honed to the specific needs and requirements of SNF and LTC facilities. Here’s how the tool addresses Salmon’s four operational areas of focus:
1. Keeping Hospital Readmissions Low
SALMON uses PointRight’s Quality Measures (QM) and PointRight® Pro 30® Rehospitalization solutions to measure, monitor, and manage quality measure outcomes and report them to stakeholders across the SNF/LTC industry. Built on real-time MDS data, these solutions allow SALMON to proactively manage their outcomes and ensure referrals of skilled patients from hospitals.
“Readmission data is the foundation of our quality measures,” Salmon says. “We have to have good data that provides accurate information and pinpoints problem areas. As an enterprise-wide operator, I can go in and look at our system at a very high level and be able to understand what’s going on and compare facilities to identify problems like why one facility has higher or lower readmissions, what factors may contribute to those rates, and most importantly, what we can we do to resolve the problem.”
2. Preparing for Survey
PointRight’s Five-Star Fast Track® solution helps SALMON interactively monitor and manage CMS Five-Star Quality Rating performance with a “What If” feature that sets targets for improvement efforts.
“Most organizations understand intuitively how to prepare for a survey, but not many institutions or individuals have a solid plan for preparation six months out,” Salmon says. “I always began preparing for surveys early. We pull out the QM report and look at what’s driving our metrics – the good and what needs improvement. If you are a non-clinical Executive Director, which I am, it gives you the power needed to talk to the clinical team. There are certain clinical topics I don’t know well, but because I have data, I can ask open-ended questions that get people talking and lead to specific actions.”
3. Managing Staffing
“How, when and where staff is deployed impacts everything we do,” said Salmon. “With PointRight, I can look at when peak readmissions are, how/if that relates to staffing, who is working and with that data, identify problems. We’ve used this tool to drastically improve the quality outcomes in the operation, time and time again. So, for example, we note we are getting a lot of admissions on Friday and readmissions on Saturday. I use that data as a basis for a conversation with hospital discharge staff to discuss what is happening (likely the hospital is slammed over the weekend) and what we can do. PointRight is the basis for that important conversation.”
Each month Salmon reviews several reports developed exclusively for SNFs by PointRight, including:
- Pro 30 Facility Summary, which shows how SALMON is performing with rehospitalizations,
- PDPM Insights, which reports on facility-level PDPM outcomes in key areas that affect reimbursement and other key PDPM KPIs, and
- QM Facility Summary, which reports on MDS-based PointRight-calculated quality measures.
4. Improving Census
PointRight helps the company get a single source of the truth for key metrics such as their census, allowing the company to make strategic decisions about census and their mix of services with confidence. In addition, PointRight is an essential sales tool that SALMON uses to increase referral traffic by clearly presenting their unique capabilities, including care quality vs. competitors.
“PointRight is a data rich pool that can help us run every aspect of our business,” said Salmon. “When it comes to census, it gives us a clear view of our census and allows us to do what-if scenarios to plan our optimal census levels. In addition, it helps us secure more hospital referrals because we have all the data referrers care about at our fingertips. I can demonstrate key statistics such as our 30-day readmission rates when others can’t.”
Maintaining Excellence in a Turbulent Market
With the organization’s commitment to quality and willingness to tackle tough decisions, SALMON Health has found ways to thrive. Most importantly, SALMON Health has used PointRight to find an optimal census for SNF and other services that allows them to best serve community needs and remain a healthy company. In addition to assisted living and active communities, SALMON now has 300 SNF beds.
Even within today’s turbulent and uncertain market, SALMON Health has achieved some remarkable results. One of the accomplishments the team is most proud of is its ongoing high-performance ratings, even during the pandemic. “We had some challenges – like the entire industry – but we identified issues and were able to resolve problems quickly,” noted Salmon. Additional accomplishments included:
- Average 4.5 stars across all facilities,
- Among the highest rated SNFs in Massachusetts and among the best-scoring nationally,
- Perform above benchmarks in readmissions,
- identify residents at risk for mortality and plan appropriate end-of-life care, and
- Highest network participation rate in the state (meaning that payers want to work with SALMON as they recognize their commitment to quality).
The Future for SALMON and the Industry
SALMON recognizes that the LTC and SNF industry faces difficult and seemingly insurmountable challenges. Is there a crystal ball to predict the future? Unfortunately, not right now; there remain many challenges and uncertainties. But Salmon and the leadership team at SALMON know that an ongoing commitment to quality and the use of the right technology and tools will be the difference between success and failure today and in the future.
About SALMON Health and Retirement
SALMON Health and Retirement, based in Milford, Mass., is one of the few family-owned businesses remaining in the long-term care (LTC) and skilled nursing facility (SNF) industries. The company was founded in 1952 by Helen and Daniel Salmon, both nurses passionate about helping their community and neighbors. Today, SALMON is a third-generation operation run by brothers Matt and Andrew.