The Nursing Home Podcast

Let’s meet Chris Caulfield RN, NP-C, co-founder and chief nursing officer at Intelycare. He has been a nurse for 10+ years and experienced a variety of work settings within the nursing industry.

Chris tells us more about Intelycare, from why it was conceived and how it continuously helps both hospital administrators, nursing homes and nurses with a system that is reminiscent of Uber.

The nursing home industry, specifically from the nursing home staffing standpoint, there is definitely significant struggle. There are more open shifts than LPN’s. There are simply more nurses that are needed than there are nurses available.

Intelycare, as in ‚Äėintelligent way of caring for residents‚Äô, aims to address the problem. Nursing agencies that works with nursing homes are typically doing blocked book assignments.

Intelycare is best known easing the gap between nurses and nursing homes, and they are continuously adding to those services.

Chris also discussed how their system rates their shifts. It is both rated by the nurses that you are passing the assignment on, and also the administrator, the DON and the scheduler.

He also relates to us how Intelycare deals with compliance, background check and licensing.

From going with a traditional agency type of recruiting, verifying licenses and references and adding more ways to verify nurses background.

He discussed the pricing standpoint of their system compared to a traditional nursing agency. He tells us how nursing homes who have used Intelycare has increased their staffing ratings, improving their future profitability.

There are also nursing homes that are exclusively using Intelycare staffing solutions, as Chris also tells us, because they can meet all their needs including consistency.

A total of 8,000 nurses and nursing assistant have worked with Intelycare.

Intelycare aims to provide a complete staffing solution for nursing homes. Helping them mange, maintain, retain their own internal staffing while supplementing as necessary.

Intelycare website:

Intelycare Facebook:

Intelycare Twitter:

The Nursing Home Podcast website:

Scott Reib is known as America’s Legal Coach. He’s the official Zig Ziglar Small Business Lawyer, a Ziglar Legacy Certified Trainer, and he has over 20 years of experience as an attorney.

For the last two decades, Scott has been helping business owners, entrepreneurs, coaches, and service providers to ‚Äúshatterproof‚ÄĚ their businesses and succeed in the

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Through his subscription-based Access Plan legal service, Scott is making great strides in shifting that perspective.

In the past, clients were scared to call Scott or any attorney because they were nervous about the cost of the conversation.

This led them to let things go on fire before they called out for help.

With the Access Plan, clients pay a flat rate per month. This ensures that they are both on the same team, and they can call him as necessary before things become serious issues.

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Reach out to Scott

ScottReib.com

What does Zimmet Healthcare actually do?

Zimmet Healthcare is a consulting support firm specializing in skilled nursing facility reimbursement, compliance and strategic planning.

Initially started as a service vendors creating cost reports and appeals for Medicare and expanded as the industry has matured.

Zimmet Healthcare currently employs about 60 people servicing about 300 facilities across the country.

Do you see a significant trend in the reimbursement method for SNFs from when you started out to today?

There’s a complete shift in SNF reimbursement.

To be frank, clinical reimbursement is a complex topic and the goal of this conversation is to get a better understanding of the big picture, the coming changes and how they will affect day to day operations of your nursing home.

With that in mind, let’s go back to Marc’s answer.

In the earlier days, reimbursement was based on the costs a facility incurred when caring for a particular resident.

The more the facility spent on the resident, the more was their reimbursement within reason.

This is now changing to a model that is based on price and not cost. There is a fixed rate per day for a residents’ condition, diagnosis and plan of care.

The facility will get reimbursed at that rate regardless of the actual costs incurred by the facility.

Why is Medicare Changing the Reimbursement Methods?

One of the biggest challenges with the current PPS/RUG method of reimbursement is that there is too much of an emphasis on the therapy received by the resident.

For example, if there are to residents who receive the same level of therapy, the facility will receive similar reimbursement for them even if one has significant other clinical challenges (such as wound care or cognitive issues etc.).

PDPM - Patient Driven Payment Model

PDPM which is starting October 2019, enhances the reimbursement sensitivity of the all the different payment drivers and takes the focus away from therapy as the primary driver of payment.

PDPM Vs. RUGs

To understand the difference in reimbursement consider the following.

We are going from a RUG system which has 66 RUG scores (of which we only use 20 or so of them), to PDPM which has almost 29,000 rate composite possibilities, which boils down to 15-20,000 rate combinations that will actually be used.

In simpler terms, with more words in the language we can be that much more precise.

How Does This Affect the MDS Process?

The MDS job description will change a bit. There will be fewer assessments, however, it will require working more extensively with the other disciplines.

Whereas in the past the reimbursement was driven primarily by therapy and ADLs, now the other disciplines will play a significant role in the reimbursement process.

For example, dietary will need to capture a mechanically altered diet. The psychologists, respiratory therapists and others will play a large part in this process.

Who is Pushing for These Changes?

The federal government is pushing for these changes. MedPac (The Medicare Payment Advisory Commission) has been almost begging congress and CMS to implement a patient specific payment model that does not recognize the frequency and duration as the payment driver because it provides an incentive to over treat the patient.

Is the Government Trying to Save Money With This?

Theoretically, this is supposed to be budget neutral.

It’s a redistribution from facilities that focus primarily on the therapy intense patients, to facilities that take the sicker, more compromised patients on the vents and trachs.

The medically complex patients reimbursement will go up considerably and the therapy intense patients will go down.

Will Facilities Make More Money in PDPM?

Zimmet Healthcare expects that facilities will get better at taking credit for the care they provide and in the first year Medicare will actually spend more than their budgeted amount.

This will be followed by a rate reduction that will recalibrate the dollars to make it budget neutral.

So perhaps in year 1, the facilities that learn and implement programs to accurately take credit for the care they provide, may make some extra money.

However, once the rate is adjusted, it should remain budget neutral.

Who Gains by These Changes?

Ultimately, these changes are indeed in the best interests of the patient.

The problem with the system is that you almost have to provide a high level of therapy in order to keep your doors open.

Let’s take the dialysis patient as an example.

In the RUG reimbursement model, the facility would lose money.

The rates are simply inadequate.

Facilities would try an aggressive treatment approach where they would take the resident to therapy early in the morning knowing that the resident will not be able to tolerate the therapy on their return.

With PDPM, this will not be necessary because the other clinical challenges will be considered as well in the reimbursement rate.

What is Changing in the Medicaid System?

Being that Medicaid is not a national system, and each state runs their own program, it’s difficult to speak about the specifics of the program.

However, in general terms, Medicaid started out as a cost based model, many states then went to a case mix and acuity model, to a priced based system and finally to managed care. This is not universal but is the general trend.

More importantly, every state has x number of dollars to spend on their Medicaid program. The main concern is not the distribution of reimbursement for the program, rather, it’s the overall total funding of the program.

An astute operator will learn to maximize their Medicaid reimbursement dollars in any Medicaid system. The problem lies in the total dollar amount that the state allocates to the Medicaid program.

Are the Articles That State the Amount a Nursing Home Loses Per Day Accurate?

It may be true that the rates are inadequate, however, the facility was never going to be profitable just by the reimbursement payments.

In order for a facility to be profitable they will need a good short term rehab census as well. This together with the Medicaid payments can make the facility viable and profitable.

If the facility was 100% filled with Medicaid patients with the right acuity mix, and everyone had Medicare Part B you would not be losing $37 a day.

Is Owning and Operating Nursing Homes Still as Profitable Now as it was 25 Years Ago?

In the early 90’s it seemed like a really simple business to run. Nowadays, it’s a very complex business.

Today, there is tremendous potential in the post acute care continuum which SNFs are such an important part of, is where the opportunity lies.

In post acute care management, there real opportunity to meet the new demands of the new nursing home residents.

A stand alone nursing facility that is well managed can absolutely be a profitable business and serve the community well.

Where are Those Baby Boomers?

We are always being fed information by the media that with the baby boomers are coming of age and nursing homes will have to scramble to meet the need.

While in reality, nursing homes are struggling to survive due to lack of patients.

As mentioned earlier, there are a variety of variables that are causing this to happen, including the push to provide for these elders within the community.

However, the statistics do show a sharp increase in the Altzheimers disease in the coming years of which 75% of those over 80 will need to be admitted to a SNF.

That is something that will significantly increase the utilization of SNF care and should sharply affect the overall occupancy.

Contact Marc Zimmet and learn more about Zimmet Healthcare at

In this episode we meet, Sarah Rayburn of VCorp Services.

Sarah went to school for broadcast journalism.

When she realized that it was a real cut throat industry, a recruiter reached out to her and brought her into VCorp Services.

With her self admitted, ‚Äėwork ADD‚Äô, she was able to quickly learn the business and she took a liking to the compliance side of the business and that became her niche.

While attending a conference at the American Health Care Association, Sarah noticed how so many nursing home organizations were struggling with precisely this level of compliance.

Often, this was not given the attention that was needed for this and the results showed for themselves.

It’s never pleasant when the facility is giving a tour to a potential resident’s family members and a police officer enters the facility and serves the lawsuit.

It’s not good for marketing.

The staff begin to wonder about the stability of their jobs and all of this could have been avoided had the facility arranged a registered agent.

This information can be shared exponentially when this event is shared on social media and before you know it, this has become common knowledge.

A registered agent will receive any notices or legal notices, service of process, state notices and other types of legal documents. The agent is then responsible to share the information with the facility.

Contact Sarah

VCorp Services

Mention that you heard this episode for 10% off on your service fee!

Intro Episode

My name is Shmuel Septimus.

I’m a nursing home administrator, podcaster, online marketer, lover of effective communication and networking.

There is a dearth of knowledge when it comes to understanding the inner working of the nursing home industry.

On this podcast we will interview the mover and shakers of the nursing home industry. They will share their unique perspectives and experience with us.

We learn together how to best navigate our way through this complex and ever-evolving world of long term care.

Looking forward to taking this journey together!

Check out my other podcast as well - The Love Your 9 to 5 Show

Alvin Kahn -Principal, Executive Director of Recruitment at Alvin Kahn and Associates

30 years ago, Alvin started recruiting for hospitals across the country. Eventually Alvin was promoted to working in the corporate office doing trainings and continued to recruit.

In 1995, Alvin started out on his own, with Alvin Kahn and Associates, a recruitment company specifically focused on the nursing home industry.

What pulled to the nursing home world from the acute care/hospital industry?

There was a group from Milwaukee Wisconsin, that started working with the rehab in the nursing home industry and they needed someone to manage their Eastern operation. Alvin was hired by this company to help out with in several states.

When that company eventually sold, Alvin was able to use the relationships he had built to go out on his own and as they say, the rest is history.

Do you help fill line staff for nursing homes for RNs, LPNs and CNAs?

AK focuses primarily on management level and above and the facilities work internally to fill the other positions.

What is your magic trick to find the candidates that are the right fit for the specific positions requested? What can you do that the facility cannot do?

We only send over candidates that are qualified and have a really great potential of being an actual fit for the position.

If you work with an online resource such as Indeed.com or Craigslist.com, even if you put the ads up correctly and sponsor them, you will still receive many, many candidates that are completely not qualified.

A good recruitment firm will only send over pre-screened candidates which they genuinely believe have an excellent chance of success. That is what is done at Alvin Kahn and associates.

The firm actually works hard to establish a relationship with the candidates to really see the full picture and understand their background. Equipped with this information, there are much better chances that the candidate will be the right candidate for the position.

Do you find a practice that the nursing home operators or candidates are doing that are surprising to you?

At times, a candidate will share more information than we find necessary. When asked why they are looking to make a change, they may share more information and details than we feel we need to know.

We understand that there are always at least 2 sides to every story.

At times there are candidates that have had a troubled past. The facilities will generally pass right over these candidates because they don’t have the time or resources to fully vet out the candidates.

As a recruitment firm, we encourage candidates to be upfront with their past and that they share any skeletons that they may have in the closet. This is in their past interest, because they will come out later and at that point, it can derail the entire process.

Retainer vs. Contingency

Retainer search firms are paid an amount in advance to be available to fill positions as the needs arise. Contingency search firms, like Alvin Kahn and Associates, are paid only if and when they successfully place the candidates in their positions.

Over The Phone

Almost all of the work that is done in finding and screening candidates is done over the phone. It’s still really effective to speak over the phone (INSERT LINK TO PHONE LIVE), and it’s working.

When a candidate comes into the office, there is lots of wasted time on the part of the candidate and the firm that could be better used to find the right candidates.

The firm is now looking to do video conferencing to add the face to face connection to the process without compromising on the efficiency and use of everyone’s time.

Is there any particular piece of advice that you wish someone would have told you earlier on in your career?

There are 2 points here.

You must have mentors and you need to learn from everyone to some extent. However, don’t listen to everyone else’s advice. What works for them, works for them. You must infuse your professional activities with your own unique talents and personality.

Additionally, it’s critical to focus on the recruitment results when speaking with candidates. You are not their social worker and all conversation and engagement should focused on that end goal.

What’s your favorite part of your business that lights you up inside?

The greatest excitement is when we find are able to successfully place a candidate with a company. We actually make a toast together to celebrate the event.

And no, it’s not just because that’s when we make our money. We get that special sense of accomplishment and joy when the candidate was not able to find employment without our help. Or when the employer was not able to fill the position on their own.

Parting Advice

The process must be taken seriously. Candidates should know the facilities well before approaching the recruiters and the facilities should also be equally invested in the process.

Links and Resources

Innovating Healthcare with Software and Technology with Alan Dworetsky

Alan Dworetsky is the director of sales and marketing for Approved Admissions.

Alan has been in the medical space for nearly 15 years started by selling durable medical equipment and then transitioned into wearable ultrasound devices. At that point, Alan found the opportunity at Approved Admissions to move into the software part of the healthcare space.

The healthcare is solid and is not going away anytime soon making it a very stable industry for the long run. Software is becoming a become part of our daily lives.

What is Approved Admissions?

There are 2 functions for Approved Admissions.

Family member will at times make changes to their HMO (insurance) plans in a way that they will no longer be covered without notifying the facility. They had no intention of paying privately and would never have done so, had they fully understood the implications of their actions.

Now Approved Admissions will notify the facility in their report that there was a change and the business office will be able to address the issue in real time.

The Manual Method

Without a software that automates this process, the facility either will wait for the denial letter from the insurance company at which point its much more complex to fix the issues.

Additionally, there would have to be someone who is manually checking every resident’s insurance individually. This is a very time consuming process and leaves the facility wide open to human error.

The goal of any software innovation is to minimize the reliance on human beings.

When was the last time a traffic light was incorrect and it displayed green instead of red?

You Must Trust the System!

If you don’t rely on the system, you will not get the full benefit out of it.

A GPS will only get you to your destination in a timely manner, if you shut off your brain’ and allow the system to help your navigate.

From Your Perspective, Where Do Nursing Home Operators Need to Improve?

There seems to be a strong push back from the nursing home staff in regards to accepting and embracing new technologies.

These innovations will actually make their jobs easier and improve the quality of the care we are all striving to provide. However, in the present, they present as a change and disruption to what has always been common practice.

Institutional Memory

Just because you are used to doing things a certain way doesn’t make it the correct way anymore. There is a great reluctance to change in any organization and that is a barrier to innovation.

Limited Resources

Unfortunately, nursing homes have limited resources which forces them to maximize the efficiency of whatever and whoever is available to them. In this environment, it’s challenging to introduce change even if it will produce significant improvements.

The bottom line is that it means more work right now and that is unthinkable in many facilities who simply trying to survive moment to moment.

What Commendable Practice Have You Noticed in Nursing Facilities?

Some nursing homes are putting kiosks in the lobby’s for family members to leave their feedback on their interaction with the facility.

They may leave a glowing 5 star review or share some criticism and a one start review. It’s encouraging to see nursing facilities that are open to hear the truth and act on the feedback they receive.

Repute iPad Review System

Repute is a system that we work with here at SNF Marketing to encourage family members and anyone who engages with the facility to share real and actionable information.

If there is a negative review, it will actually create a ticket that is emailed to the administrator and cannot be closed until the issue is resolved.

Truth be told, seeing a large iPad in the lobby of any building give the impression that the facility is up to date and pays close attention to detail. This is even before you fully understand the functionality of the system.

What is the Biggest Myth Regarding Your Product?

People believe that they can do a better job than the software or the AI can do.

This is incorrect.

Countless times the system find spelling mistakes and incorrect numbers that would have affected the claims and they ultimately would have been denied. By finding this information in real time, they facilities are savign real time and money.

Aren’t Software Companies Like Yours Rolling in Dough?

Being that your product is a software, the cost is fixed and should not matter if you have 10 facilities or 1000 facilities. So does that mean that you’re company is attaining larger and larger profits as it grows?

The real answer is that, yes, it’s true, that the cost is not affected dramatically when there are additional clients who sign up on the software side. However, Approved Admission, is constantly reinvesting back into the system.

The software is ever evolving based on changes in the marketplace, the needs of the customers and upgrading the software. An entire team of developers created, maintain and upgrade the system.

So, yes, the cost may be close to fixed to onboard another facility, but there is still a significant expense to constantly update and upgrade the system.

Links and Resources

Check Out Approved Admissions Here!

Reach out to Alan