Lost in The Woods
While it is officially known today as “The Maneuver Support Center of Excellence” Fort Leonard Wood back in the day was for me and my active army peers, as well as locals, known as “Fort Lost in The Woods”. Located between St. Louis and Springfield Missouri this fort was at the time, the most isolated place I had ever been in and the feeling at times was overwhelming. And, lost in the woods is really where many long- term care organizations find themselves today. The isolation that many organizations are experiencing is due to significant outside and inside factors. First and foremost, chronic underfunding of Medicaid and Medicare “adjustments” are the behemoths most negatively impacting long term care. Yet, there are so many other contributing issues as well.
For example, many organizations cannot increase the acuity level of residents they want to admit for higher reimbursement rates due to continued staffing issues, poor referral relationships with hospitals and physicians, inability to provide necessary clinical training and competencies, or are geographically located in a surrounding community that simply cannot support a need for increased specialized services. Nursing home acquisitions continue at a fast pace. And as private equity investments in nursing homes continue to soar the for- profit nature of these investments (according to many articles) are showing data that seems to support lower quality of care and higher mortality rates which are obvious and serious deterrents for any potential new referral sources and increased admissions- of course leading to more isolation.
Then there is the self- imposed isolation that organizations continue to perpetuate. Since coming out of the pandemic the “we can do it all ourselves” philosophy has not proven to be working. And this isolation has only served to impair leadership executive function for making decisions and sound strategies to position for short term success and long-term sustainability. Overcome by dwindling government funding, continued staffing issues and thinned margins many organizations have not really given proper attention to some specific operational areas that just may help them thrive. One such area that is significant in supporting the organization is the MDS. Many organizations have not asserted a routine check of their MDS health-which by the way is essential for organizational health as the MDS is responsible for reimbursement, compliance and even care quality. Since the pandemic MDS staff have left buildings in mass due to workload stresses often leaving new MDS Coordinators to fend for themselves. There are also significant MDS changes occurring on October 1st and many organizations admit that they are ill prepared for these changes. The Medicare Part A PDPM reimbursement model still eludes many organizations for efficiency, accuracy, compliance, and reimbursement optimization. New, useful technologies are on the rise, yet many organizations do not have the bandwidth needed for research and cost- comparing to procure these. Nor are they able to ensure continued proper use of the technology by staff and are often unable to identify and effectively utilize needed analytics for benefit.
Isolated facilities are at a grave disadvantage. The burden is heavy on organizations and there is much at stake. Leaders need to understand risk versus reward and execute beneficial partnerships that are no longer a luxury but a necessity as a valuable resource for viability. Outside experience and expertise should not be understated nor overlooked.
During my time at Fort Leonard Wood, we had a survival training component where we were dropped off in pairs into the thick woods and we would have to find our way out to a designated location. It was the partnership that ensued between two strangers that forged beneficial strategies that helped us survive and ultimately got us out of those woods. Could I have survived and gotten out of those woods on my own? Why would I want to find out if I didn’t have to?
Article written by: Michael F. Masse, OTR/L
