Case Studies – Skilled Nursing

Challenge

Client owns 37 Skilled Nursing Facilities in the Midwest and the South and needed a President/COO who could create standard processes to improve efficiency in operations and increase profitability.

Candidate Placed

Chief Operation Officer: This is a hands-on operator with 12 years as a multi-facility operator in the Long Term Care industry. They were responsible for 135MM in annual revenue, 1500 employees, an average census of 1500 with a Medicare/Managed care number of around 380.

• Improved Profitability by an average of $1.45 Million annually
• Increased Part A Rates by over $30 per day on average
• Improved Medicare Part B revenues by $700K over each of the prior2 years

Challenge

The Client owns over 100 Skilled Nursing facilities and had a division of 21 facilities that needed a VP of Operations who could take ownership and hold Administrators accountable to the systems and processes.

Candidate Placed

VP of Operations:  This candidate is a has a B.S. degree and over 15 years’ experience in the Skilled Nursing industry including their current role overseeing over 35 SNFs/ALs across multiple states. Below are a few of their accomplishments

• Within 5 months posted annualized operating margin results $10MM improvement over prior year and best OpM results dating back to 9 years
• Growth of 5% quality mix and 8% average daily census
• Implementation of Upper-Level Payment program to add $18MM in Medicaid revenue

Challenge

This Client owned 20 Skilled Nursing facilities in the Westen US and the VP of Operations was promoted to the COO position and needed a VP of Operations who could increase Census and NOI in their under performing facilities.

Candidate Placed

VP of Operations: This is a licensed Nursing Home administrator with a Therapy background with 7 years of multi-facility experience and has been with the the same company for 3 years overseeing 50 facilities consistently exceeding $500 million operating revenue annually

• Because of his therapy background he is able to market to ACO’s and get in the door. He makes 4 marketing calls per day even though he is wearing 2 hats
• Reorganized operations to improve operating Margins and outcomes: Increased Margins by 5%
• Achieved Targeted Margins of 20%

Challenge

This Client has 10 very resort styled Subacute Rehab centers located in the Northwest and a VP of Operations who could improve operational efficiency through process implementation and accountability.

Candidate Placed

Regional Vice President:  This is an MHA candidate with over 20 years of experience in multi-facility skilled nursing center operations, who has have developed market strategies, specialty programming and several start-up plans for new centers.

• Improved the star rating for a large number of centers by leading efforts in survey management, center staffing and quality measures
• Consistently scored below 1.0 on the Health Deficiency Index for all states within my responsibility
• Exceeded financial targets routinely including bottom line, hours of labor, expense management, reimbursement rates and workers compensation as evidenced by reaching bonus level incentives for both myself and my team
• Established census development plans that were market specific and resulted in increased occupancy

Challenge

This Client has 9 Skilled Nursing Facilities in the South and the East Coast and needed a Chief Finance Officer with a strong accounting and technology background to replace the CFO who was retiring after 30 years.

Candidate Placed

Director of Financial Operations: this candidate has a BS in Accounting and is responsible for the oversight of Financial Operations for 15 Assisted Living and Memory Care Communities, 2 Independent Living Communities, and 2 Skilled Nursing Facilities in the 5 states. Prior to this she was responsible for accounting functions for 57 Skilled Nursing Centers.

• Created financial operating plans with a focus around a 25% operating margin
• Created systems to monitor accounts receivable and improve collections
• managed start up and acquisition of 9 of the 19 communities in a 2 year period

Challenge

This Client has over 50 Skilled Nursing facilities in the Northeast and wanted to move their current CFO into an operations position.

Candidate Placed

Chief Financial Officer: This candidate has a Masters in Business Administration and responsible for 110 Skilled Nursing and Assisted Living Facilities accounting for $1.3 billion dollars in revenue.

• Developed and implemented the strategic plans, policies and procedures for providing the financial resources to conduct the company’s business, safeguard its assets, measure and report the results of its financial performance.

• Established major economic objectives and policies for the Company to achieve maximum profits and increased revenue.

• Promoted to Senior Vice President of Operations Finance for entire company portfolio (7 Billion in revenue).

Challenge

This Client has 15 Skilled Nursing Centers in the Southeast and needed a CFO with a strong accounting and Accounts Receivable background to replace the current CFO who retiring.

Candidate Placed

Chief Financial Officer:  This candidate has more than 14 years’ experience in the senior living industry starting in a facility and moving up to corporate, almost 2 years as a Financial Controller over the largest senior housing provider in the southeastern US with communities in eight states.

• Developed a Regional Business Office Manager program to have regional support to increase AR collections to a minimum of 98.6% within 30 days.
• Performed both Medicare and Medicaid Cost Reports for North Carolina
• Developed an accounting team and strategy that made company history by completing year end for all facilities by deadline of March 15th.

Challenge

This Client has 63 Senior Living communities with a combination of Skilled, Assisted Living/Memory Care and Independent Living in the Northwest.

Candidate Placed

Chief Accounting Officer: This candidate has a BS with a major in Accounting with over 15 years in Skilled Nursing Industry with experience managing Accounting and Financial Operations teams.

• Multi-Facility Portfolio’s including 22 SNF, 8 ALF, 3 LTACHS with one company and currently 23 SNF, 3 ALF (used to be 33 SNF).
• Developed Labor Management and Staffing Tools that led to a $5M dollar reduction in labor costs.
• Partnered with Clinical and Operations team to develop FOCUS Strategic Business Plans to improve outcomes.

Challenge

This Client has 29 Skilled Nursing facilities in Texas and needed a VP of Accounts Receivable who could replace their current VP of Accounts Receivable who was moving to another city to be closer to their family.

Candidate Placed

VP of Revenue Cycle: This candidate is responsible for billing and collection activities for all providers on behalf of 22 Skilled Nursing Home Communities.  She hires, mentors, develops and supervises billing team constructed of 4 Managers covering Accounts Receivable, Analytics and Systems/Process, 3 Regional BOM positions, and 17 Billing Team Members. 

• Accountable for nearly $200M in Accounts Receivable while producing 98% or greater collections.
• Proven track record of continuous improvement of operations through the use of best practices in the billing division to maximize cash flow and reduce ADSO.
• Established Bad Debt Allowance methodology by payer to recognize risk of bad debt based on historical metrics and natural billing cycles.

Challenge

This Client has 23 Skilled Nursing facilities located in 2 Southwestern States and needed a VP of Accounts Receivable who had an accounting background who could create systems resulting in a reduction of the DSO for their company.

Candidate Placed

VP of Revenue Cycle: This candidate has 15 years of demonstrated experience and proficiencies with accounting procedures dealing with accounts receivable, financial management and business analytics. This Candidate manages 9 regional AR, 12 central billing office staff, and over 75 business office managers.

• Lead implementation Facilitator for roll out of 55 facilities migration to Point Click Care between 5/2012 and 12/2012.
• Maintained average DSO of 31.2 for 75+ Long Term Care Facilities even with tremendous consistent company growth over the past 14 years.
• Consistent team collections of average of 95% or above of Prior Month Revenue·          

Challenge

This client owned and operated 37 Skilled Nursing Center in multiple state in the South and the Midwest and needed VP of Reimbursement who could create efficiency and a strategy in their Cost Reporting process to maximize their revenue generated.

Candidate Placed

VP of Reimbursement: This candidate has a BA in Accounting and a Masters in Accounting with over 20 years experience of performing Cost Reports or overseeing the department responsible for cost reporting.

• Oversees Cost Reporting department for over 50 Skilled Nursing facilities in multiple states.
• Prepare & file Medicare, State Medicaid Cost Reports, and States Enhanced Staffing reports for multi-facility Nursing Home Health Care Group that also owned other lines of health care business.
• Also prepared and filed the Home Office and Home Health Medicare cost reports. Provided Staffing and Medicare analysis.

Challenge

This Client owned a 360 bed Skilled Nursing facility in Queens, New York that was 5 Stars in every category and needed a VP of Nursing who had a track record running a large facility, with a history of deficiency free surveys and 5 Star ratings.

Candidate Placed

VP/Director of Nursing: Master’s Degree with nurse executive certification from ANCC, Medical/Surgical certification from NYPQ.  Currently pursuing DNP with less than a year for completion. Nursing Professional with over 20 years of experience working at all 5-star Nursing Homes. 

• Nursing Executive Professional with a proven track record boasting excellent DOH survey ratings at every post.
• I had five DOH surveys within the past year and passed all of them with no deficiency.
• Built the census and kept the facility at 96 to 98 % occupancy at both current facility and previous facility.

Challenge

This Client owned five Skilled Nursing facilities in the Boston market and 4 out of 5 where 5-Star, voted the Best Nursing Home of the Year award by the US News and Report and had either the Bronze or Silver award and needed a VP of Clinical Reimbursement to replace the one who resigned during COVID.

Candidate Placed

Regional Clinical Reimbursement: This an RN with 4 years as a Regional Clinical Reimbursement Specialist and 14 years as an MDS Coordinator. Below are a few of their duties

• Developed & implemented MDS compliance audits to decrease regulatory deficiencies across my district within 4 months of beginning position
• Provided strategic leadership on MDS & reimbursement process across State that includes 24 SNF facilities.
• Developed and implemented teaching , training & competency programs related to MDS process, Quality Measures management, 5 star ratings, and QAPI practices.
• Provided education and training as well as oversight of transition from ICD 9 to ICD 10 coding

Challenge

This Client owned five Skilled Nursing facilities in the Boston market  and needed Corporate Director of Human Resources who could bring standardization to facilities by getting the buy in from the Human Resource Directors in each facility who were accustomed to working autonomously.

Candidate Placed

Corporate Director of Human Resources:  This candidate has ten years of HR experience working in the skilled nursing industry, five as an Assistant Administrator and Licensed Nursing Home Administrator.   

• Successfully defended MCAD, EEOC and unemployment cases- no MCAD/EEOC case has moving beyond mediation.
• Developed and conducted Managers Workshop, training hundreds of mangers on Positive Coaching and Corrective Counseling, Employment Law, Leave Management and Interviews and Selections (972 total trained in FY 2019).
• Participated in (from the vendor selection process to the training/implementation) the successful roll out of a new applicant tracking and a new time and attendance system
• Participated in the successful roll out of an electronic health record, Point Click Care.

• Challenge

This Client was a new company with 20 Skilled Nursing facilities all located in the same state in the Midwest and they needed a VP of Marketing that was willing to take a risk with a start up company. This was a new position so the VP of Marketing would need to build from the ground floor up.

Candidate Placed

VP of Marketing: This candidate has a BA in Gerontology and over 20 years as a VP of Marketing and Sales in the Senior Living industry.

• Regional sales and marketing manager responsible for 12 business units and sales force of 22. Developed team sales skills through coaching and training.
• Lead the development and marketing strategies including account management, new business sales and program development and community alignment
• Conduct C- level meetings within key accounts and strategically align centers with the PPN’s of each hospital system; including outcomes reviews, needs assessment and alignment opportunities
• Monitor and evaluate data input systems; including sales activity, referral activity, review trends and make needed market adjustments to meet budgetary goals

Challenge

This client just purchased this Skilled Nursing facility and had invested 10ML to upgrade and needed an Administrator who could turnaround this 1-Star facility.

Candidate Placed

Executive Director: This is an LNHA/former Regional Nurse Consultant for one of the most respected LTC organizations in the US. This candidate has a consistent record of being used to turnaround difficult facilities.

• The candidate won the Silver AHCA Award in a facility that had previously struggled. This facility was Medically Complex with Dementia residents
• Assisted in implementation of Policy and Procedures while in Regional role
• Responsible for financial over-sight of the facility

Challenge

This Client owned a 250 Bed Skilled nursing facility located in Georgia and needed an Administrator who could increase census and improve the Payor MIx.

Candidate Placed

Administrator: BS – Long Term Healthcare. LTC leadership for the past 7 years. Has led various size facilities of up to 228 beds with diverse acuity including overseeing a large remodel and opening a highly specialized behavioral health facility. 

• Successfully recovering over 100 COVID 19 patients as my current facility was designated for this task within the overall company structure. Maintained a deficiency free infection control survey.
• Increasing CMI at every facility with the latest resulting in a +$17.28 to MCD PPD
• At previous facility led improvement to an overall 5 Star ranking with CMS
• Managed the 3 Million dollar remodel and reopening of a highly specialized Behavioral Health facility.

Challenge

This Client has a 5-Star 200 bed Skilled Nursing facility in North Central New Jersey and needed a Director of Nursing who could replace the former DON who suddenly passed away. This Client will only hire from the top talent in their market.

Candidate Placed

Director of Nursing: This candidate has a RN/MSN with a master’s degree in Health Care Administration with over 20 years of Director of Nursing experience in rehab/ LTC nursing with 16 years with the same organization (Genesis).

• Candidate is well known by surveyors and has maintained 4 and 5 star ratings.
• Their current facility, averages over 200 admissions a month.
• Led facility from a 2 star to a 5 star CMS quality rating Led facility to “Center of Excellence Award”.
• Guided facility from a CMS 2 star to a 5-star compliance quality

Challenge

This Client manages very upscale CCRCs that are know as “Life Planned” communities and needed a Director of Nursing for 55 bed SNf that was part of a CCRC campus

Candidate Placed

Director of Nursing: This candidate has a RN/MSN with a master’s degree in Health Care Administration with over 20 years of Director of Nursing experience in rehab/ LTC nursing with 16 years with the same organization (Genesis).

• Candidate is well known by surveyors and has maintained 4 and 5 star ratings.
• Their current facility, averages over 200 admissions a month.
• Led facility from a 2 star to a 5 star CMS quality rating Led facility to “Center of Excellence Award”.
• Guided facility from a CMS 2 star to a 5-star compliance quality

Challenge

This Client had a 5 Star 110 bed Skilled Nursing center locate in Northern New Jersey and needed an MDS Coordinator who could perform Care Plans, improve accuracy as well as submit.

Candidate Placed

MDS Coordinator: BA in Nursing, MA in progress . Certified Gerontological Nurse 15 years of Long-term care experience with the last 3.5 years leading MDS in a 110 bed high-volume Rehab facility. Responsible for monitoring patient’s medical charts, completing assessments and recording medical information

• Assess, formulates and implement individual care plans for residents in facility.
• Collects assessment data on all the residents on the SNF, ensuring that these data elements are encoded in the MDS and submitted to the CMS according to a strict mandated schedule.
• Clarify documentation misconception and identify patterns of documentation for 
• Ensure skilled services plans are followed and are backed up by documentation .