Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency
Interview with Robert Van Dyk, President and CEO at Van Dyk Health Care
Kris Mastrangelo, President of Harmony Healthcare International (HHI) interviews Robert Van Dyk, the President and CEO of Van Dyk Health Care in the 2017 AHCA Provider Lounge. Robert shares his key tips for being a successful health care provider amid the sea of regulatory change. He stresses the importance of collecting and then analyzing data in order to get a seat at the table with the other health care players: ACOs, Hospitals, Managed Care, etc. (Audio transcription below).
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Kris Mastrangelo: Good afternoon today we're here with Bob Van Dyk president and CEO of Van Dyk Health Care. How are you doing Bob?
Robert Van Dyk: Good Kris.
Kris: Great we're at the 68th AHCA/NCAL Annual Convention. Lots of people here today, lots of questions. Bob, we're seeking some guidance and insight from you. Could you tell us a little bit about your organization?
Robert: Sure. Ours is a family owned. My dad started the company in 1953, so 64 years right now. I took over the company 24 years ago. We presently operate two skilled buildings. We have an assisted living facility. We have a memory care center within our system. We have a home care company and we're now breaking ground for daycare for people with Alzheimer's and Dementia.
Kris: So very strategic. You have the continuum of care and you're located in New Jersey. Could you tell us with the changes that are occurring regulatory and reimbursement-wise, what keeps you up at night?
Robert: Well what's keeping me up is the number of changes and how quickly they're occurring. It'd be one thing if there were changes being passed down and we had time to adapt and we had time to train, but we're getting so many changes so quickly. That is causing me to stay up at night and what's happening is I'm having to add staff in order to develop new policies and new procedures, the training of all the staff on the new policies and procedures. There's a lot of time and money being invested in trying to keep up with all these regs and that's probably the thing that is most challenging for us is the number and the speed at which we could keep getting hit with the regulations.
Kris: And there are two things that come to mind in that context. Number one: do you think that the speed is a product of technology, meaning the word can get out faster me and the assumption is that well I sent you this information that one would roll it out quicker but it's not really that easy to do. So is how is technology influencing your facilities.
Robert: When I talk about the speed I'm not really talking about technologically. I'm talking about how quickly CMS is coming out with new regulations one right after the other. New forms of reimbursement being suggested and you look at one right after the other and trying to keep up with all of that we're just having to devote so many man hours just to reading the new regulations, understanding them and then how we're going to be able to implement them across all of our homes. And that is the speed. There's so many so fast it's overwhelming
Kris: And I understand that. So, the mega rule the draft which came out not this past August, the August before, was 800 pages. So, to distill and synthesize it took weeks and then they have the follow up rule and in the first part of this Requirements of Participation it talked about the patient population and the complexity - how it has evolved in the skilled nursing facility setting. Where I think I'm going is that the mandates the requirements are so intense and complex and fast there has to be some reimbursement for that. If you are going to train educate and add more staff… that's where I'm hopeful because the expectations are person centered care, facility assessments and I agree with you 100% it requires more manpower.
Robert: Yes, all across the board. You're correct - it's going to take a lot more manpower to do everything we need to do and from a reimbursement point of view there's no hope in sight. We're not paid extra for doing more. The expectations are somehow do more with what you have and oh by the way do it better than you're doing it with what you have and it's a struggle at times trying to understand why they think we can do that. I will say we do everything we can. We try very hard. We work very hard at accomplishing those tasks to those ends but it's going to be a challenge.
Kris: Have you done anything that would be helpful for the viewers to hear and because you know you've been successful - you are successful - and you're getting through this, but maybe you figured something out that would be helpful to the viewers.
Robert: Well if we're talking about just the regulation side that's one piece, but if you're talking about how are we navigating through all of the – I don’t want to say just the reimbursement - but this new era of health care. You know, we're being looked upon and the expectations are that the post-acute care facilities are going to help keep people from being readmitted. We're sort of in that middle. The hospitals are discharging more quickly. We have the patients, if we have the patients at all, we're expected to care for them quickly, get them home and then hopefully do it in such a manner that once they're home there's no need to go back to the hospital. So, the hospital is giving them to us sick and we're having to care for them and make sure that they don't have to go back to the hospital. So, you know the concept of lower length of stay, shorter readmission, better outcomes. Oh sure, piece of cake. Some of the things we've been doing in order to do this is we're specializing and so we've developed cardiac programs. We have our trademarked Heart Ways that is a cardiac care program. We have an in-house cardiac nurse practitioner. We have a very robust pulmonary respiratory program. We have in-house respiratory therapists, respiratory therapy, nurse practitioner. We have a pulmonologist who comes through a couple days a week. Our length of stay on pulmonology and respiratory cases just blows the national average out of the water. I mean we went from here all the way down to there. Same with cardiac care. Our length of stay has dropped, our readmissions are dropped, our outcomes have improved. So, what we're trying to do to be relevant and be here for the long run is our goal is to become the preferred provider of the hospitals themselves and health systems in our marketplace and the things we're doing have actually worked. We're a 5-star facility. We're a preferred provider. We have the specialty programs. One of the other new specialty programs in development is wound care and so we're going to have to be specialists. We're going to have to be the best at what we do and in doing so our belief is the hospitals and others will recognize that. A friend of mine just yesterday was saying he's trying to do all the right things but the hospitals are not paying attention and my advice is keep doing the right thing. It's not an easy road for us, no one said that this industry, this profession was easy and so my staff said why are we doing this, we're not getting more patients and I just keep going back to: do the right thing, outcomes are going to be critical and collect data. If I had one piece of advice to anyone watching of my peers is data collection, data collection, data collection. I don't know if you remember a management guru named Deming?
Kris: I did my thesis on Deming and I did in healthcare. You are preaching to the choir.
Robert: So, Dr. Deming is attributed…this quote is attributed to him: In god we trust, everyone else bring data. And that is really where we are in our health system. We as post-acute providers must be collecting copious amounts of data, analyzing that data so that we can show the ACO, the bundlers, the hospitals, the health systems, managed care, Aetna - you know, you name it. I've been doing this for a while and I haven't always felt the love right away because some of the hospitals and health systems themselves aren't sure what to do with all this. They're all still struggling. Many of them are still struggling to figure out where they're going to fit, how they're going to make money in this whole population health concept. So, I've been doing it regardless of the love and we're now starting to see that respect and that they're coming to us. They're including us in meetings. We are now at the table. We'll get an admission that's too soon, ends up being readmitted - instead of now blaming us we're going to them and saying you admitted them too soon. we do a pre-assessment. We get back to the hospital and say I know you want to discharge them today but we believe if you keep them for one more, two more days there won't be a readmission. And their confidence in us is growing and growing. And that's my advice to my peers and my friends and colleagues just keep doing the right thing. collect lots of data and I think it will come.
Kris: It's interesting. I've never met you prior to this and three things that you hit on is: number one, I'm a big believer of Dr. Deming and I think that the requirements of participation are threaded in with it. Number two, respiratory therapy because the number one cause of the hospital readmissions is respiratory related. So, you're actually on top of your game. Data, Respiratory Therapy, Specialize, because when you complete that facility assessment you then need competencies, so that specialization will give you the efficiency of continuing with your success. We thank you so much for coming today and good luck with everything. We look forward to seeing you soon.