Interview with Paul Liistro, Owner & CEO - Arbors of Hop Brook
Kris Mastrangelo, President of Harmony Healthcare International (HHI) interviews Paul Liistro, Owner and CEO of Arbors of Hop Brook (CT), in the AHCA Provider Lounge. Paul relates his previous experiences of working in a family run nursing home with one piece of technology to working in his current facilities that utilize multiple software systems and cloud technology. With so much data, Paul discusses the importance of data analytics, including the possibility of even hiring a Data Analytics Nurse. (Audio transcription below).
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Kris Mastrangelo: Good Afternoon. Thank you for joining us at the Provider Lounge at the American Healthcare Annual Conference. Today we’re here with Paul Liistro. He has an organization in central Connecticut. He’s the owner and CEO of Arbors of Hop Brook. Hey Paul, want to tell us a little bit about your organization?
Paul Liistro: Thanks Kris. I want you to know that I’m flattered and honored to be here. Harmony Healthcare has got an imprint, a real big footprint in our industry and we’re glad that you’re there. Thank for the invitation. I am very much like many independent owner/operators. I’m second generation in the business. My mother started the business because she was a licensed practical nurse working in the hospital and she didn’t like being told what to do by doctors so she and her sister – she had five other siblings, six total - all got into the nursing home business in the late 50s before Medicare and before Medicaid and then of course when Medicare and Medicaid came they started growing and building and at one point in time my family would have owned twenty percent of the nursing home beds in the state of Connecticut – in 1980. We were never one “company”, we were family businesses making a living, making a difference and we had transitioned in late 1985, 1990 we started moving. I came back to the business. I was working way, I’d gone to business school, came back and then decided to get into the business and I’ve been working in the business ever since.
Kris: We’re lucky to have you. I mean, with all the changes we need savvy business people to help us with all the reform, all the changes, value-based purchasing. Tell us a little bit about how you see the future and maybe some strategies you can share with other owners.
Paul: Sure. I’d be glad to do that. You know, having been brought up in the business I had swept out a lot of construction debris in the business because my uncle, my mother’s brother, was a contractor and I had 20 cousins, 15 were old enough to sweep a broom and haul a shovel and we would go to all the relatives’ nursing homes during the 60s and 70s and we would clean them out. When they were open, I did everything except care give. I worked in the kitchen. I was in maintenance. I mowed the lawn. I stripped the floors of was. I put wax on and those are the things I did. We had no technology. I used to joke as a matter of fact that the only technology we had was a four-channel intercom that went from the nurses’ station to the administrator’s office to the kitchen and the fourth channel came to our kitchen in our house that was a hundred and fifty feet away from the nursing home. My mother would get on the phone and say “Go Back to Work. Stop chit-chatting!” I say that because you asked about some of the trends that are affecting us and for the first time in the last five years or so technology has been making a huge difference in many different ways and what we’ve been focused on ever since five-star got elevated this past summer with adding five more quality measures – four of them adding to the five-star component – we have focused on using technology to be as good as we can be in survey. Payroll based journal is going to be taking care of payroll and payroll goes up and down as census goes up and down and the only real benefit you can do is hire registered nurses and we have also looked for some technology to help us with the quality measures and we’ve found them and we’ve started to employ them. And everything – I’m not sure if it’s a cause and effect – but now what we’re seeing is that while the staff members are putting information in, their having a hard time analyzing, having a hard time understanding what does it mean. So now we’re looking into creating a position called a Data Analytics Nurse. The Data Analytics Nurse actually is someone who is very savvy with the clinical aspects of what goes on in the nursing home, but he or she does not have to be in the nursing home. They can be working from home in their casual clothes, plugging into our systems because most of what we do is in the cloud, downloading the analysis, looking at specific patient impacts and then communicating back to the patient care planning team to do better patient centered care. I look at that as productivity and in an industry where it’s people caring for people, we’re providing care to people who need care and it’s sometimes hard to understand what they really need unless you start seeing all the data come together and so we’re seeing technology make a big difference to our business. Now if I’m disgruntled about one thing, no one’s paying for it. So, we’ve got a hardware issue and many years ago we went from - I think they were called - blade servers and we had a server for everybody’s application and then we went to virtual servers and we had a more fluid system, but now that system is old and we need to replace it and we need to go to the cloud, but probably have some stuff on site, some information being collected. The software is getting more and more and more as I indicated. So, we’re using an EHR and they’re great partners except every time we plug into someone else’s software they want to get paid for doing it as well as the third-party software and so it becomes more expensive and they don’t give you a break. And I’m a very aggressive and assertive user of their software. We have a lot of software.
Kris: Feedbacks a gift. And when you talk about software and this data analytics component, I’m extremely intrigued by it because we were so excited to get the data and the information, but one needed to pause and say wait a minute – someone has to interpret it because with that volume of data comes time, so you have to identify what is the value and what is not. And no one has said this to me and I’m going to use it as my tag line right now: data analytics professional.
Paul: Well you know just as an evolution in our facilities, Kris…different roles get assumed, get created and then the relationships we have with – maybe even with Harmony Healthcare – change because you see a lot of different environments, a lot of different outcomes, a lot of different mission-driven providers and you might be able to come back with best practices, you might be able to interpret the data better than we can because what I’m looking at doing is creating something from the ground up and I’m still not sold on that’s the right thing to do so I’m looking for my providers, my third party consultants if you will, to be taking a new evolutionary role on because we need the information. I should tell you we have two different buildings. Between the two buildings we used to have 800 admissions a year. One building had 500, the other had three. We are now having 1200 admissions a year. We’ve gone up in three years over fifty percent. I should tell you that our length of stay has gone down – so the lines have crossed if you will.
Kris: That’s more work.
Paul: It’s more work and so we need to figure out how to do it more efficiently. Requirements of Participation have become another layer…but I have to tell you that the philosophy we have with the Requirements of Participation is if you understand the perception of CMS of our business you’ll understand their intentions and so I’ve taken that and I’m drilling it into my staff and we’ve all bought into it because what it really means is that there are certain facilities that do things to cut corners. They have a disagreeable patient come into their building – whatever it may be – might be a psychiatric patient or might be a behavioral patient, might be a bariatric, might be a very medically complex patient and they’re looking to discharge them. Well CMS doesn’t want that to happen. CMS is raising the bar and they want us to become clinically astute at what we’re doing. What does that mean? Accept only those people who you can take care of so you can take care of them and be more focused on their individual care – make it more interdisciplinary. That’s why they want a CNA on the care planning team. So, once you have an understanding of the perception you can deal better with what we have to do and that’s why we are creating tools, tips and templates to get through the Requirements of Participation. We’re not going to struggle with it, we’re not going to complain about it. We’re going to say it’s just another way of making us all better and it’s a coach telling you to stroke harder, run faster, jump higher and it’s going to make a difference.
Kris: Wonderful. It’s going to make a difference. Thank you Paul Liistro for coming today.
Paul: My pleasure Kris.