While the clinical teams at post-acute and long term care facilities are working to provide excellent care for residents, the business operations staff are busy behind the scenes laboring to keep the engine running. Business operations teams face some of the same challenges their clinical colleagues face, plus a few of their own. Nonetheless, they are using technology, partnerships, and teamwork to keep things moving while planning for the future.

A Short Story of Staffing

Much like the clinical side of facilities, business operations staffing took a hit during the COVID-19 pandemic. Some people left the field and others retired. As a result, said Helen Bautista, LNHA, administrator at Bridgeway Senior Healthcare, “we have worked hard at our recruitment process, and we really try to promote from within.”

Recently, for instance, Bridgeway promoted a medical records staff member to a business office job. “She had been in medical records for years and wanted a new challenge. We thought she was a perfect fit,” Bautista said. While the new role required some training, she said, “we try to take this kind of approach to help combat the staffing challenges.”

She noted that even when outside applicants have experience in business operations, it is rare to find those with a background in or knowledge of long term care. “It’s hard to find people who can hit the ground running when they come in if they do not have any experience in long term care,” Bautista explained. “We have found that people from within our own organization or from within the industry have a higher probability of success in a new role because they understand our mission.” When training has to start from scratch, it can be time-consuming and expensive.

In the way that facilities and organizations partner with nursing and medical schools to attract clinical staff, some long term care providers are connecting with area schools to engage students interested in billing, purchasing, accounting, and other areas. “We partner with a few high schools in the area, where students come in for volunteer hours. These experiences had typically focused on interactions with residents, but we are now working toward the development of a program that gives students the opportunity to understand how various departments—including the business office—work together,” said Bautista.

Agility and flexibility are key in business operations. “We ensure that everyone in our business office and admissions department are cross-trained on key tasks and know the overall responsibilities of each team member,” Bautista explained. “This gives us some flexibility if someone is out sick, goes on vacation, or a position is vacated for some reason. This helps to ensure that the team can continue to function despite absences.”

During the pandemic, many business operations team members got used to working remotely, and now having employees come back to the office can be a challenge. “We live in an era when people just want to work from home,” Bautista said. “We have noticed during interviews that a work-from-home option is a frequently asked question. Our strategy is to accommodate this on an as-needed basis to give potential candidates the opportunity for flexibility when it is needed. However, we have seen that on-site work creates a teamwork environment and lets people engage with the residents.”

To Outsource or Not

Outsourcing is a viable option, especially for smaller organizations that don’t have in-house experts. This approach can be as broad or narrow as an organization chooses. It’s possible to outsource entire management teams or small segments of services, such as IT, food service, and accounts receivable/payable. Medical data entry is among the most common outsourced nonclinical services in nursing homes. Other outsourced services include billing and coding, receivables, IT support, and insurance claims processing.

Outsourcing can enable the organization to provide specialized expertise, cost savings, and enhanced services. It also enables organizations to scale services up or down based on demand.

Jay BiereHowever, it also can lead to a loss of control and cohesiveness, concerns about data security, and inconsistency in quality. Jay Biere, CEO of Plymouth Place, said that outsourcing is hit or miss in long term care. He offered, “I think you should outsource if there’s a situation where there are significant labor challenges or shortages or if you are having difficulties in a particular area.”

He added, “I eliminated outsourcing when I came here, but I know how it works and when it is useful or necessary.” He further shared that he wouldn’t hesitate to outsource again if Plymouth Place “didn’t have the skills or competency resources to do something, and I was assured of the quality we would receive.”

Biere also noted that partnerships and joint ventures might be valuable or necessary when an organization adds an entity or a service. For instance, Plymouth Place just launched Plymouth at Home, a new service offering care, home management, and home-improvement solutions for local residents. He explained, “We have two partners that we work with to provide the services, and they handle their own billing and business operations; so, in essence, it’s a joint venture. Our company provides a concierge manager to interact with the customers.”

This manager follows up with clients in their homes to make sure they are getting what they need and to make sure nothing falls through the cracks.

To ensure that the service partners share Plymouth Place’s values and mission, Biere said, “we vetted them years ago. They work here in our local community, and we know their quality, character, services, and commitment to excellence.”

Taking Charge with Tech

While we may not have high-functioning robots to do many office tasks as some old sci-fi movies suggested, technology is playing a key role in business operations. These tech innovations are streamlining and simplifying tasks, taking some of the potential for human error out of certain activities, enabling ease of data collection and analysis, and enhancing communication and information sharing.

“Much like the clinical staff, business operations is always looking for ways to be more efficient and accurate. Any time you can save a couple of clicks and a few minutes, it can add up to significant time savings,” said Tom Haithcoat, president of Ceptor Consulting, LLC. He stressed that one important role of technology is to ensure that everyone—business operations and clinical teams alike—have the ability to share and access information. 

Increasingly, he suggested, facilities are using technology that prevents staff from having to waste time chasing people down for information and answers.

Haithcoat noted that larger organizations may be better positioned to create solutions on their own and have customized technology, while smaller companies may have to depend on “off the shelf” tech, so he stressed the importance of finding vendors with experience in long term care and who can offer the biggest bang for the buck.

“AI is prolific, and we’re hearing about it through the industry,” said Anthony Laflen, vice president of value-based care innovation at PointClickCare. Organizations are using AI predictive analytics to help forecast patient costs and needs.

Anthony LaflenThere is an array of software solutions for the business of senior and long term care. The best of these is designed to streamline and connect programs like electronic health records, electronic medical records, marketing, and billing. They are often cloud-driven and include built-in analytics and a secure interface, and they are designed to reduce problems presented by human error.

For instance, there is billing software that flags missing information or issues that could cause a claim to be denied. These types of innovations, said Laflen, “streamline the ability for a patient to move from one setting to the next and make sure they land in the right place in a thoughtful manner.” This technology ensures the flow of information from the clinical to the business operations side and gives all team members the information they need to fill their roles.

Cloud-based platforms are no longer a luxury but a necessity. “Facilities need to make sure that when there’s a disaster or an emergency, it doesn’t disrupt the flow of communication, billing, and recordkeeping. Business operations and clinical teams both need to be able to access tools and data remotely, which,” said Laflen, “is an obvious function of being cloud-based and enables your teams to continue to work if they are out of the office for days or weeks.”

With technology comes the risk of cyberattacks, and business operations teams have to stay on top of these risks. This calls for everyone to be attuned to the importance of cybersecurity. “Our chief information officer is very on top of cybersecurity and making sure we are as secure as possible,” Bautista asserted. “We’re constantly running updates and tests.”

Purchasing Prospects

Group purchasing hasn’t changed much over the years, but facility teams are getting savvier about choosing partners. Biere said, “We have three partners for discounted pricing on items such as maintenance supplies and food. We try to look for partners that not only have competitive pricing but reliability and consistency.”

He added, “It’s important to reevaluate partners every other year or so to make sure that you’re getting the right dividends and rebates. There are a lot of companies out there that will make all kinds of promises and commitments, so we try to target those that have good price integrity and follow through on support, as well as the opportunity to earn some money based on our volume.”

AHCA/NCAL has partnered with Incite Strategic Partners to offer a group purchasing program to help providers save on food, medical supplies, services, equipment and other common supplies utilized by senior care communities. All facility and company sizes are welcome to join the GPO, and sign-up is free and easy. Learn more at www.incitesp.com/ahcancal.

According to the Healthcare Supply Chain Association (HSCA), group purchasing will save the health care industry up to $456.6 billion in the next 10 years. The HSCA also states that group purchasing helps organizations, such as nursing homes, that need to demonstrate their value to payers and patients alike. The vast majority of the nation’s hospitals and long term care settings belong to at least one group-purchasing organization. However, all nursing homes and other health care organizations can purchase off-contract, and many do.

Planning for the Future

As the industry moves into value-based care, business operations teams need to understand the implications of this care model on billing, purchasing, and the bottom line. “This likely means a shift away from traditional Medicare to Medicare Advantage plans, and everyone needs to know what this means for your organization. You need to understand the value you’re creating and be able to speak that language in clinical care and business operations alike,” said Laflen.

This information will benefit facilities seeking to partner with any risk-bearing entity, as the facilities can then say, for instance, “we have 80 patients in our facility and strong numbers in terms of reducing costs and readmission, as well as improving outcomes.”

Laflen noted that when business operations and clinical teams have the right information and analytics, they can be stronger players in value-based care. He added, “Time and time again, I’ve seen buildings close because they did not realize they were sitting on golden opportunities to quantify their value and confidently take on risk.”
Looking ahead, business operations teams need to be involved in planning for how the organization will reposition itself to move into value-based care models. “If you remain the same, you have difficulty staying in business,” said Biere. “You need to prepare for changes in the marketplace and labor force and shifts in mindset of the customers. You need leadership teams—including in your business operations—who can think outside the box.”

The Clinical-Business Connection

It is important to remember that the clinical and business sides of facilities don’t function in a vacuum. “Everything we do has a domino effect,” Bautista explained. “Everything from housekeeping and laundry to dietary and administration all go back to the resident. If things aren’t working efficiently in one area, it impacts others. Maybe it doesn’t directly affect the physical well-being of the resident, but it does trickle down to impact care.”

As a result, every department needs to be connected within the organization, and there must be mutual respect and an understanding of the goals and mission. This can be more challenging in larger organizations. Newsletters, email updates, stand-up meetings, and online dashboards, for example, enable people in different departments to see what is happening throughout the organization. “When everyone is on the same page, no one is getting blindsided or feels like other departments are getting more attention or information,” Bautista said.

Laflen shared, “When I began interacting with operators in different parts of the US, I was stunned how often they would not include the business office or even the admissions office in the clinical narrative. It’s only when you bring both sides together that the real magic starts to happen.”

Having a full view of a patient and the patient’s experience, as well as the cost impact on operations, is key. Laflen noted, “It is important to have business leaders in the building understand what is happening clinically in the facility, and the clinicians need to understand the nuances associated with costs of care and the impact on the facility’s bottom line.”

Joanne Kaldy is a freelance writer and communications consultant based in New Orleans.​