Mr. Daniel Fessler, LNHA
On Monday, November 5th, Penn State's student chapter of the American College of Health Care Administrators (ACHCA) welcomed Mr. Daniel Fessler as our guest speaker. Mr. Fessler is currently a Regional Director of Operations at ManorCare.
During his presentation, Mr. Fessler discussed his career path. While he did not anticipate a career in healthcare as a Business Administration major in college, his entire career path thus far has been in long-term care with ManorCare. He went through ManorCare's AIT program, obtained his NHA license, worked as an Administrator at several facilities, and is now a Regional Director of Operations. Mr. Fessler credits his ability to oversee so many diverse operations to his original AIT training that helped him establish a broad interdisciplinary foundation.
Mr. Fessler also explained ManorCare's merger with ProMedica. This merger effectively expanded ManorCare's resources to include several acute care services. It also transitioned ManorCare from a for-profit organization to a non-profit organization. ProMedica's scope of services now includes acute care, home health, hospice, physician groups, insurance, and long-term care such as skilled nursing and assisted living/personal care. ProMedica will be making significant capital investments in several ManorCare facilities to implement newer and more advanced technologies as well as renovations to update their grounds. Well Tower owns ManorCare's real estate investment trust (REIT), while ProMedica owns their operations.
Furthermore, Mr. Fessler summarized current challenges in long-term care. One major hurdle has been staffing, especially nurses and CNAs. Many ManorCare facilities use agencies to fill this gap, which comes at an extra cost, but they are trying to reduce the usage of this service. They also use regional recruiters to help advertise openings and evaluate compensation packages to ensure they are competitive. While financial incentives can be efficient, ultimately the company culture and effective leadership will both recruit and retain quality employees.
Rehospitalization was another issue identified and is scrutinized by all healthcare service providers as an extreme cost. Staff at ManorCare review monthly which residents have been rehospitalized and why. They attempt to find the root cause for the hospital visit to try to prevent it in the future. One effective solution they have found is to have a Medical Director from a local health system for each facility to oversee those residents and coordinate their care.
In addition, Mr. Fessler mentioned the switched towards PDPM (Patient-Driven Payment Model) by CMS. Beginning next year, CMS will pay for skilled nursing based off of a diagnosis code rather than per day of care, providing a lump sum to pay for care and it will be up to the facility to take care of the patient using that money, keeping any leftover or assuming any costs over that. This payment model will shift from a quantity-focused model to a quality-focused model. This will undoubtedly switch incentives and alter how care is delivered.
Another topic of interest is length of stay. 17-20 days has been a recent goal for Mr. Fessler. A shorter length of stay must be balanced with trying to prevent rehospitalization. If necessary, you should keep a patient a week or so longer if it will prevent rehospitalization. Sending them home unprepared is not worth it if it will lead to a rehospitalization.
Lastly, customer satisfaction is a key factor to consider. Mr. Fessler said that customer satisfaction will soon be a 5-star CMS Nursing Home Compare category. He also said that high customer satisfaction scores are highly correlated with little/no complaint visits by the Department of Health.
Thank you Mr. Fessler for your insight into current trends impacting long-term care!
