Harmony Healthcare Blog

AHCA Provider Lounge Series: SNF Staffing Amid Regulatory Challenges

Posted by Kris Mastrangelo on Thu, Apr 05, 2018


Edited by Kris Mastrangelo

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


Interview with Don Pelligrino, CEO and Owner of Bridgeway Healthcare

Kris Mastrangelo, President of Harmony Healthcare International (HHI) interviews Don Pelligrino, CEO and Owner of Bridgeway Healthcare in the 2017 AHCA Provider Lounge.  Don discusses his staffing challenges in the ever-changing regulatory landscape.  Don believes that no matter how good your outcomes are, without quality staff, running a successful SNF is going to be a challenge.  Despite all challenges and regulatory uncertainty, Don's buildings have both achieved Five-Star ratings.


Allow Harmony Healthcare International (HHI) to provide targeted and focused recommendations to improve operational success in your SNF, while minimizing your risk of exposure from a compliance perspective.  Click below for a complimentary Risk and Revenue (RUG) Analysis.  

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Transcribed Audio: 

Kris Mastrangelo: Good afternoon we're here at the 68th AHCA NCAL Annual Convention with Don Pelligrino from New Jersey.  He's CEO and co-owner of Bridgeway Healthcare in New Jersey. Welcome Don.  We're very excited to have you and hear some insight and particularly we want to know what's keeping you up at night with all the changes happening?

Don Pelligrino: Obviously with so many changes hitting our industry at one time the big issue that we're having obviously is the implementation of the rules of participation. That's a big challenge for our staff right now.  A lot of our staff is concerned about the time that's necessary to be on top of all these changes and the volume of the paperwork and rules that we have to conform with while still servicing the residents that we're required to take care of and doing it very well.  The other issue is, you know, getting to know your data now.  We're a healthcare provider but data is gigantic.  The more that you know your data the better that you're able to interact with accountable care organizations, your hospital systems, the insurance companies. So, you really have to be on top of that.  The other big thing being from New Jersey is they've implemented matters of long-term care support services, Managed Medicaid and though it was a good intention not much went into determining the rate setting in the future.  They didn't work off cost reports any longer and we've been working off of old rates that they've been slowly adding some CPI adjustments to, but as an operator we're very nervous until they can finalize the rate-setting methodology.  How is it going forward and how do we plan accordingly?

Kris: New Jersey is one of the Case Mix states. Some people don't know what that means.  Their MDS derives a RUG level. And I heard recently that you were transitioning so you weren't a Case Mix state or you were…vice versa?

Don: We were but now with MLTSS Medicaid you know we're just getting a, you know, a flat rate.  It's working off of an older rate that we've had with minor changes. The problem is they're not taking data in to determine, you know as a cost based system and adjusting your reimbursement accordingly, they're not taking that into account. So, they really need to any states that come into Manage Medicaid they need to really set how are they going to be dealing with rates in the future.  Is it going to be a cost-based with reporting and everything is based on data but it should be doing that to make sure that we reimburse properly. Especially with the challenges in New Jersey whether looking at minimum wage overtime stepping up.  So there needs to be a methodology to adjust the rates to make sure that we can meet all these changes for you know minimum wage as well as their rules of participation and alike.

Kris:  Thank you so much.  What about immigration or things of staffing and you mentioned minimum wage?

Don: So, a lot of it with the current administration with some of the good things, and hopefully they do follow through, is where every new regulation that they come up with that they, especially in our industry which we're I feel they've kind of gone overboard and there's a lot of regulations that may be duplicate, so if we could lose two regulations for adopting every new one and do it intelligently.  But the other big challenges as an independent operator is immigration. No matter how great your outcomes are, if you can't get quality staff that's coming in...and my partner, their family has been with us in the business for 37 years and trying to deal with the different communities that we worked with for a long time immigration was very key to our success, but you know we need an immigration reform and we need it soon because all of our operators in our communities are struggling to either retain staff and no matter how good your outcomes are if you don't have enough quality staff that's providing it it's going to be a challenge. So, I really think that one of the biggest issues that we need to, and I know it's a kind of a hot topic, but we definitely need some type of immigration reform.

Kris: I'm from Massachusetts and I hear that they're putting on the ballot this year we're going to up the minimum wage to $15 an hour, is that something that…

Don: In New Jersey they're currently going to be electing the Governor shortly and some of the stands are is that we they definitely do need right now where the minimum wage is set is it’s too low for someone for the cost of living in New Jersey.  It does need to be stepped up but they're talking about doing it over time so hopefully we'll be able to adjust and react to it but obviously we have to help set you know in in Medicaid reimbursement and alike to make sure that we're getting the proper reimbursement so that we can pay these people a good wage as well as meeting all the other challenges to the regulations that were having.

Kris: And you know that staffing then leads into the Five Star because the Five Star has the three components: the health inspection and the staffing and the quality measures. So how does that even play into this?

Don: I'm glad that you asked that because the Five Star is something that does keep me up at night.  Both of our buildings are Five-Star rated. But you never know in the future where a survey could go.  You know a lot of times there's something that could be a minor issue and it could lead to a deficiency or depending on the survey or how they view that deficiency. In New Jersey I've been trying to work with our state officials, I’m on the Health Care Association of New Jersey committees, and looking at having some type of reform through the survey process for the independent review.  So at least now we can have a true independent review because right now we as we appeal our deficiency that may have been found there needs to be a little more dialogue to come back because it does impact our star rating which again can affect our standing in our ACO since it's three stars or minimum. So hopefully that it could be reviewed and more people have input if in fact a deficiency does come out and that it gets weighted accordingly.

Kris: And Five-Star – congratulations! One more quick question.  The survey process and you'd mentioned that you know of course if one appeals it then it delays the certification, but the new proposal to take QIS, merge it with a new way to have the integrated reliability of the survey, I hear that. What about the civil monetary penalties specific to New Jersey? Has it gone up? Has it gone down?  I know where it is nationally, but I'm curious to see in New Jersey.

Don: Tom Coble has done a great job with the civil monetary penalties. New Jersey has really not been impacted too harshly with the civil monetary penalties.  They're out there but we're not like other parts of the country that have had been impacted to a greater degree. I think that the inroads and Tom as being the chair of HCA and focusing on that and did a fantastic job. Where now CMS has gone back, looked at it and they’re relooking at the scope and severity and how it should be, you know, rated out. So, like anything else with all the changes, the rules of participation, the civil monetary penalties, even, you know, the new RCS scoring systems they're going to need to evolve over time and as long everybody looks at these are imperfect systems and that they're going to talk to the providers because it's in our blood, we’ve been doing it for 37 years. And the people that are in our business are special and many times through the regulation they want to do the right thing but sometimes they overreach and it actually becomes counterproductive and until they can get the immigration and all these things together the biggest complaint I get from my staff is we're overwhelmed with all this regulation and I don't know if I continue on today, I want to care for patients and not worry about all these other issues now that we have to deal with.  So hopefully I believe we're on the right path.  Mark Parkinson and everybody is providing great leadership and I really believe that, you know, there is a great outlook for our industry.

Kris: That's great.  Well we're grateful for your time. Grateful for everything.  Don Pelligrino from New Jersey, thank you so much.


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