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The Affordable Care Act introduced many policies and regulations which will have immediate, short-term and long-term effects on the Long-Term Care industry. Most relevant to your buildings’ bottom line are Accountable Care Organizations (ACOs). What is the best way to stay on top of the ever evolving world of ACOs and what immediate actions should you take to protect your facility in this new world?

First, it is important to understand that all ACOs are structured differently. Some might be established by hospitals, while others by physician groups. Regardless of an ACO’s leadership, differences will also exist in the payment structure. An ACO can choose between three different models as it relates to Medicare reimbursement and shared savings plans. The key is not to know how every single ACO works, but rather to focus on the ACOs that will directly affect your facilities. As new ACOs are approved and announced via CMS, find out which ones are in your service area, which ones are potential referrals, and which models relevant ACOs are following.

Setting up email alerts to receive up-to-date announcements is a great way to make sure you are aware of developments in your area. Google has a free email alert service that can be set up here. Keywords to set alerts for are: ACO, CMS, Shared Savings, and Accountable Care Organizations.

As the LTC industry continues to evolve, providers need to be more focused on resident-centered care, with a particular emphasis on quality of life. This is important for many reasons.

Compliance with the new quality-of-life requirements from the Centers for Medicare & Medicaid Services is sure to impact bottom-line results. Surveyors are paying closer attention to how SNFs are focused on the resident, including the creation of homelike environments or “neighborhoods” which enhance quality of life in-line with resident preferences.

This leaves facilities with the responsibility of actively seeking information relating to resident preferences and choices, and attempting to accommodate them as best they can. If a SNF has not done so, surveyors will require them to provide an explanation.

Step 1: Turn your short-term rehab patients into “ambassadors” for your facility

It’s no secret that there’s been a significant increase in the growth of this group over the past 10 years, and statistics show that 40% of short-term rehab patients return to the senior care system in just 7 months.  By making every effort to achieve high levels of satisfaction, you will not only ensure that many of your former patients will come back to you, they’ll also become a great source of word-of-mouth referrals and admissions.

Keep in mind that short-term rehab patients bring with them a whole new set of criteria in terms of achieving high levels of satisfaction.  They are, for the most part, younger and more discriminating in what it takes to satisfy them and their family members.  Focus on meeting and exceeding their expectations by developing specific quality service standards, and make sure all employees are fully trained on those quality service standards.  

Last week I wrote about the first four steps in designing a LTC website design.  To review, when building a website, there are many factors that you should keep in mind in order to maximize your online presence.  The purpose of a LTC website is to engage seniors and families so that they contact you via email, phone, online form, or perhaps even a visit.  Part two of this blog will focus on the rest of the nine necessary steps that need to be taken to make your website a new referral source that generates its own inquiries.

Step Four: Individual pages for clinical services

As mentioned above, it is very important to describe all of your clinical capabilities. Each service should have its own dedicated page on the website. If you have one page with a listing of all of your short term rehab services, it forces visitors to search through the text until they find the service most relevant to them. Instead, create a dedicated short term rehab tab on your menu bar along with a drop-down list that displays all your short term rehab services. With drop-down lists, users can find the page they are interested in with just one click..

When building a website, there are many factors that you should keep in mind in order to maximize your online presence.  The purpose of a LTC website is to engage seniors and families so that they contact you via email, phone, online form, or perhaps even a visit.  This two part blog will focus on the nine necessary steps that need to be taken to make your website a new referral source that generates its own inquiries.

Step One: Easy navigation

The quickest way to lose someone who is viewing your website is to make it difficult for them to navigate through the site. Have a menu bar on top of the page that displays the main areas of your site, along with drop-down sub-menus so that every page is accessible with one click of the mouse. Ensure your site does not have any ‘buried’ pages that are only accessible after two or more clicks from any page on your site.

For a large amount of the population, the internet has become a digital playground; an area to share thoughts, ideas, information, a place to research and obtain knowledge. LTC facilities need to take advantage of this and turn the internet into their newest referral source opportunity.

Most people know this already. But now what?!? The first step is developing a website. Not just any website, but one that is designed from the ground up by LTC experts to get your organization found. From navigation to content a site developed by someone who knows our industry will get you found and help you stand out.

While having a website is crucial, it is only the first step in helping your facility get found. The website needs supplementary pieces (legs to stand on), in order to be found. A website without legs is like an unlisted phone number. Yes it exists, but no one will be able to contact you.

Typically, marketing is thought of as running print ads in the local newspaper or having a listing in a senior reference guide. While there may be some value in these programs, one of the most overlooked audiences to communicate with is your internal audience. Everyone always talks about how word-of-mouth referrals is key to generating inquiries, but few owners or operators actually take advantage of this “lowest hanging fruit” opportunity.

The internal audience can be defined as anyone who already “knows” you and has a relationship with you (either current or past). This includes residents (especially for ILs and ALs), family members / responsible parties of residents, short-term rehab discharges that have successfully returned home, donors (for non-profits) and staff. Everyone listed here can turn from friend to referral source if the relationship is leveraged effectively.

Today, marketing plays a key role in creating inquiries for you to turn into admissions.  With newspapers closing up shop in favor of online web papers and with most research today done online, it’s only a matter of time before all media and marketing is digital. However, right now and for the foreseeable future traditional media must take a prominent role in marketing activities.

The AARP recently conducted a study on the usage of internet among midlife and older adults.  Their findings while not unexpected clearly highlight the reality we live in. Nearly 68% of the people surveyed age 50 and older do in fact use a computer, either at home or at work.  What this means though is that nearly 32% of this important demographic does not use a computer at all, not even at work.  So, the time to dedicate all your marketing activities to the digital world is not yet upon us, unless of course you are you willing to neglect a third of your market share completely?

In order to get full value from your marketing campaigns, you need to find the right balance between digital and print media.  In some markets traditional media will be prominent and a digital program will supplement it. In other markets digital marketing will take precedence.  To determine what balance is correct for your organization, test out your marketing campaigns in both forms; then, most importantly, track the source of inquiries as they come in.  After a certain amount of time, you’ll be able to analyze the data and determine what’s working and what’s not, giving you better information to make the appropriate adjustments.

As healthcare reform is constantly evolving, there is always a need to protect your Medicare market share.  While the long-term care community enhance their marketing and communications efforts to address this concern, it is important to remember that word of mouth is still one of your best referral sources.  Making every single person who touches your building an “ambassador” to the public is key to keeping your building full.  Here are a few simple ways in which your building can increase their word of mouth referrals.

Make the most of every opportunity: It is important to remember that word of mouth can be influenced.  Take advantage of the opportunity that exists with every person that touches your building-from long-term care patients, to your short-term rehab residents, their happy family members and your employees.  Don’t be shy to ask each person’s permission to use their “story” and their outcomes when communicating with the hospital and physician referral sources.  Ask for written testimonials, thank you notes, audio and video testimonials and pictures.

“It takes 20 years to build a reputation and five minutes to ruin it. If you think about that you’ll do things differently.” – Warren Buffet

Protecting your LTC building’s reputation has never been more important. Inc. Magazine recently reported that 97 percent of consumers conducted online research to find local businesses. The information about your senior care facility that’s available on the web is absolutely critical.

Customer reviews, social media mentions and online name visibility directly influence a senior care provider’s ability to generate inquiries, referrals and admissions. A strong online reputation promotes consumer trust and is a testimony to your high quality of care, while negative reviews, or a tarnished online reputation, can cost an LTC facility thousands of dollars in lost revenue.

A three step plan for getting found online

Monitoring and tracking performance

Perhaps one of the most satisfying aspects of a digital marketing program is that you can actually measure results.

A properly built and managed website allows you to track the number of people visiting your site, when they visited, and what information (content) attracted their interest.  This information provides the insight necessary to help you engage more people.  The more people you engage, the more opportunities you have to generate inquiries through your digital marketing program.

In addition, performance can be measured by comparing the number of visitors and their actions on your website with the promotional activities you are using to drive traffic to your site.  This gives a clear view on exactly what’s working and what’s not so you can maximize your marketing ROI.

A three step plan for getting found online

Step Two: Get Found

In my last article I discussed creating a digital footprint, the first of three necessary steps to using digital marketing to generate inquiries, referrals and admissions (click here to view). This week I will discuss the second necessary step to getting found online - promoting  your content in an efficient & effective manner.  Over 60% of people searching for healthcare services turn to the internet first.  People are looking for the services you offer, but do they know that you provide those services?  In order for them to find your building’s digital footprint, you must employ a variety of tools that attract people who are actively searching.  Since the majority of internet information is found through a search engine, ensuring that your building appears in the first few results is key.  Search Engine Marketing (SEM) allows your building to immediately compete for that prize real estate at the top of the search results.  However, make sure that your SEM campaign is built by an expert in the LTC community who knows how consumers looking for LTC services behave when searching online.  Otherwise you will end up with a generic cookie cutter SEM program that will not deliver the desired results.  Make no mistake; being among the first results that appear on an internet search is a powerful endorsement.  From a practical perspective, it usually means you’ll be the first facility they’ll consider.

A three step plan for getting found online

Step One: Create a digital footprint

The central location for all digital activities is your website. It serves as a hub for all your online communications. In digital marketing, your website acts like the front door to your facility. It is your opportunity to make a good first impression. A well designed website with the right functionality will work to immediately engage visitors – using the content on the site to quickly create a positive feeling about you and your credibility as a senior care expert.

Most people have heard the expression, “in the digital world, content is king.” That’s because the content on your website is how you communicate. It’s through your content that people get to know you. It’s your content that is the “story” of who you are and what you do. A successful digital marketing program requires that your content communicates a powerful, positive “story” about who you are, what you do and why you are the best option for the care needed. The website and its content are your building’s digital footprint.

In my last article I discussed the second of three necessary steps to ensure you get “invited” to join the ACO of your choice in order to protect your Medicare referrals. (Click Here to view)  The third necessary step to protecting your Medicare referrals in the ACO environment is understanding that not every SNF will be invited to participate in the ACO of their choice; some may be left out. What are your options if you find yourself “outside” your preferred system?

Keep in mind that consumer choice will play an important role in the era of accountable care. This means that communicating with consumers now – to establish awareness of who you are and the quality care you provide – can be essential to protecting your Medicare revenues.

Why? Because of two important reasons: First, consumers will have a choice of where they want to receive post-hospital care, so you want to make sure they can ask for you by name. Second, enhancing your image with consumers also helps to establish your image with referral sources.

In my last article I discussed the first of three necessary steps to ensure you get “invited” to join the ACO of your choice in order to protect your Medicare referrals. (Click Here to view)  The second necessary step to protecting your Medicare referrals in the ACO environment is recognizing that you will need to reduce re-hospitalizations – especially for those Medicare Part A referrals that are within the “30 day window” – starting right now.

Although many facilities have begun to focus on this area, simply reducing your rate of re-hospitalizations isn’t enough; you must also track that performance and communicate it to your referral sources. Begin protecting your Medicare revenues right now by asking yourself the following questions:

In my last article CMS Announces First ACOs Under Medicare Shared Savings Program I discussed the recent CMS announcement of the formation of the first 27 ACOs under the Medicare Shared Savings Program and some of the challenges that providers will begin to face regarding their referrals.  This article will discuss the first of three necessary steps to ensure you get “invited” to join the ACO of your choice in order to protect your Medicare referrals.

Accept the fact that reform will take place and that it will change referral relationships. There is no question: the need to lower costs and improve outcomes through better coordination of care will result in some form of Accountable Care Organizations (ACOs) in your marketplace. What can SNF management do right now to get “invited” to join the ACO of your choice and maintain or improve its referral relationships? Start by answering these questions:

• Are you perceived by referral sources as providing quality sub-acute and rehab care?
• Does every referral source know about your clinical capabilities?
• Do community physicians know how successful your rehab program is in returning short-term patients to their homes after a hospital stay?

The formation of Accountable Care Organizations has begun with the recent CMS announcement on April 10, 2012.  The announcement included 27 ACOs spanning 18 states, with the goal of improving care for almost 375,000 beneficiaries.  This now brings the total number of Medicare beneficiaries participating in various shared-savings initiatives to 1.1 million.  All ACOs that do well in providing high quality care, while reducing the costs of care, may share in the savings to Medicare. 

Five of the 27 ACOs are participating in the Advance Payment ACO Model, where each ACO will receive advance payments to help cover the costs of establishing an ACO infrastructure.  Additionally, CMS is currently reviewing more than 150 applications from potential ACOs that are looking to join the Shared Savings Programs starting in July.

Healthcare reform, although yet to be finalized, has already begun to impact skilled nursing facilities and their hospital referral sources. In fact, CMS recently announced that beginning October 2012, hospitals will be penalized for excessive re-hospitalizations. In 2012, the penalty will be 1% of Medicare payments and will then increase by an additional 1% in each of the next two years, to 3% in 2014.[1]

In addition to the mandated reduction in re-hospitalizations, improving outcomes at all levels of care will be one of the major goals of the reform legislation. This means that with the formation of Accountable Care Organizations will come the added challenge for SNF’s to demonstrate successful outcomes. Those skilled facilities that are recognized for good outcomes will be rewarded with increased Medicare referrals; those that do not prove their successful outcomes – regardless of their reputation until now – will be at significant risk to lose market share of Medicare referrals.

Part 2: What can I do over the next 12 months to protect Medicare revenues

In my opinion, three facts are clear: First, much remains to be finalized about health care reform; second, there is no doubt that health care reform will soon be a reality. And third, reducing costs and improving Medicare outcomes will remain a central objective of the legislation regardless of any changes.

In light of those facts, here are suggested priorities around which management can implement programs that will maintain or increase Medicare referrals and revenues over the next 12 months:

• Make sure your building’s name reflects that you are an expert in short-term rehab and sub-acute care. If it doesn’t, but instead sounds like that of a traditional nursing home, consider changing the name or adding a tagline that highlights your rehabilitation capabilities.

PART 1: What can you do right now to prepare for change

Concerns about the impact of healthcare reform and interest in ACOs are growing among LTC leaders. Increasing numbers of owners and operators are sharing with me that the uncertainty about the future has caused them to delay or cancel important decisions and shift priorities: all because they await clarification of how healthcare reform will actually impact their market, their referral sources and their revenues. Is it smart for SNF’s to adopt a “wait and see” approach? Or are there things you should be doing now, even before the legislation is finalized?

To help shed some light on these questions, and to get a better understanding of the pace of change taking place in the industry, let’s look at the findings of a recent survey of how the ACO model of care is being adopted by hospitals nationally.