Philip ScaloJackson Township in central New Jersey has as its official motto: A Place for All Seasons, which if applied to one of its key employers, Bartley Healthcare, could instead read: A Provider for All (Your Senior Care) Needs.
Situated roughly 90 minutes or so from New York City to the north and Philadelphia to the west, Jackson is where Bartley’s expansive campus is located, and where Philip Scalo, the company’s president and chief executive officer, calls home.
In an interview with Provider, the veteran nursing care leader says Bartley has grown from its inception in 1985 as solely a skilled nursing operator (120 beds) to its current profile encompassing the full continuum of long term and post-acute care (LT/PAC).
The range of services makes Bartley a provider for all needs, from post-acute care and rehabilitation to skilled nursing, memory care, and assisted living. There is also palliative care, the interdisciplinary Step by Step Program, and Bartley at Home Services.

Lay of the Land

In assessing the current state of the LT/PAC profession, Scalo ticks off a list of major challenges and, later, ruminates on the opportunities that the aging U.S. population will offer those providers prepared for what changing demographics and tastes mean.

Near the top of the list of challenges that Bartley—and likely most providers—face is filling staffing needs. Scalo sees the improved economy as a workforce issue, leaving fewer people to train as nurses, and even when trained, a real test to keep them in the long term care profession.

“They want to be in hospitals. So, what we are seeing is they get experience with us and then they say, ‘now I want to go big time.’ It is almost like we are a training ground for RNs who then go to hospitals,” Scalo says.

Another demand is the perennial issue of reimbursement. “Obviously, this is much more of a challenge than it was five years ago,” he says, pointing to his home state of New Jersey as being especially tough given changes in payment models there. “It is both reimbursement by rates being paid and by the timing of payment, which is increasingly becoming a problem,” Scalo says.

The burden of regulation has also weighed on the business, given the complexity of the Requirements of Participation as implemented by the Centers for Medicare & Medicaid Services and the peculiarities of New Jersey oversight.

“We have seen over the past few years in New Jersey that the state regulators have less experience. So there are more and more people coming in without experience and actually understanding what happens in a skilled nursing facility or assisted living facility. They don’t understand the business, which makes it very, very difficult if they want to serve it,” he says.

Managed Care Arrives

Amid these changes is the growth in managed care. Health insurers contracted by the state to run portions of its Medicaid business are in theory focused on increasing efficiencies and improving quality of care, but to Scalo that is mere theory right now, given what he sees.

“Managed care has taken on greater involvement. The question is are they managing care or managing money. Increasingly we see them managing money and not managing care,” he says.

This is because of the nature of many of the managed care companies, which are not on the ground to assess which care options are best for patients. “The challenge is to maintain a high level of quality, as we have done for 30-plus years, while other forces are talking about quality, but in essence in many ways make it a bigger hurdle to get to quality results that we are expected to deliver,” Scalo says.

In speaking to a managed care operator, he says they admit their staffing levels are not sufficient in many cases to make the best care management decisions. Often, he says, these decisions on where to place patients after their acute-care stays are made from afar and many times skip the LT/PAC setting in favor of the cheaper home care option. This can lead to readmission woes for the patient and hospital.

“We often see people’s care cut off because a managed care company feels they can go home. But what they don’t see is geriatric rehabilitation is a delicate thing, and a balance must be in place. You can go home and not have the proper equipment or supervision and not as good of care as you would finishing up in a subacute facility,” Scalo says.

Making the Case for LT/PAC

To prevent this type of decision making, Bartley partakes in an aggressive case-by-case marketing campaign to convince hospitals and managed care companies through evidence-based data that their facilities are a vital link in the care chain.

“We now have an internal case manager program where we follow up when people discharge from our facilities, and also follow up with people who may have come to our facility,” he says. This hands-on approach centers on face-to-face meetings between patients and the care team, be it in the facility or at home.

“And then we require the home care companies we make the referrals to report to us on a weekly basis on where they stand. Then our case managers and social workers have a program where they follow up with people after they are discharged,” Scalo says. “That helps to a large degree to keep people on track and to be able to find out if they are not on track and whether they need to come back to us or if they need some more concentrated home care.”

What the Future Holds

While Bartley works in the present to be an important partner for referring hospitals and managed care companies, it also is preparing for the expected wave of newly elderly populations that will require nursing or some other form of LT/PAC as baby boomers age. Scalo says simple supply and demand will likely increase the need for services that Bartley offers, but as the demand grows so will the requirement for providers to change.

“I think that the [baby boomer] patient/resident is going to have different demands, more service-oriented demands,” he says. That means more consumer-focused care, with expectations higher for quicker resolution of problems, more technology, and more access
and niceties.

“The days of someone going to a physician’s office and having the first appointment of the day and still having to wait three hours to see them is just no longer going to be the case. So we are more consumer-oriented,” he says.

This means Bartley is gearing its physical plans to have more private rooms. More of a sanctuary type of room as well as delivering more services to residents and patients. “We have a program called Bartley at Home where we bring meals and we bring different services into the home and we bring some of those people onto the campus for different services. It is about concierge services,” Scalo says.

Service Remains the Core Mission

Scalo says Bartley is prepared for these challenges. Mainly, because even as the advances in technology and new reimbursement models have fundamentally altered the way in which business is done, there remains the truism that has guided the company for four decades: treat residents, patients, and their families as they would their own family.

“It all [consumer-directed care] fits right in to the approach we have had in place since the beginning. Everyone’s job description in my company, including mine, has a primary responsibility to take care of the needs of the residents. We have been focused on that, it is what drives our business. The customer is always right,” he says.

And, in turn, because so many Bartley staff live in the area, it is this mantra to market by word of mouth that sticks year after year. “You know, frankly, being a provider in a community where you reside and most of your staff reside means you want to be in the situation that if you have on your ID badge when in the supermarket, you want someone to come up to you and say great things about your facility,” Scalo says.