Search form

LeadingAge

 Ziegler received a number of questions over the years regarding the sales and marketing staff compensation, specifically as it relates to commission for these individuals. We devoted the last poll of the year to this topic.

The Ziegler CFO HotlineSM poll was conducted between December of 2014 and January of 2015. The survey included questions on sales and marketing staffing, and budgeting and compensation, specifically the topic of commissions. A total of 182 organizations participated. 

Among the 182, roughly 60% were from single-site organizations and the remaining 40% represented a multi-site provider.

The initial survey question gathered input on whether or not the organization pays commissions to their marketing/sales staff. The vast majority, 70.2% indicated that they do pay commissions to this group of employees. The multi-site organizations are more likely to pay commissions than single-site providers.

For those who indicated that they do pay commissions, they were asked about the timing of the payment of those commissions. The majority, 75.5%, pay commissions on a monthly basis while the remainder pays on a quarterly basis. 

Given that many commissions are often paid in installments, a question was asked about how providers split the payment of the commissions. 

Roughly 7 out of 10 stated that they weigh the payment heavier on the settlement side. An additional 20% stated it is split evenly between deposit and settlement and 10% are heavier on the settlement side.

A series of questions were included regarding budget and expenses. The table below shows the percenage of the overall budget that is devoted to marketing. On average, organizations devote roughly 3.9% of the overall budget to marketing, with single-sites budgeting 3.4% and multi-sites 4.7%.

The annual marketing costs per budgeted sale varied across survey respondents. The largest proportion, roughly 41%, reported that it is $10K-$20K per budgeted sale. For 3 out of 10 of the respondents, $10K or less is budgeted per sale. The graph below shows the results from this question for single-sites compared to multi-site organizations. It should be noted that a smaller number of respondents answered this particular question (N=129).

Questions about staffing were included as well. Overall, organizations on average staff one full-time marketing/sales position per roughly 140 residents. There were no significant differences observed between single-site and multi-site organizations.

See the full survey results. For more information on Ziegler's CFO Hotline polls, or anything included in this article, please contact the Ziegler banker in your region.  

 This article was written by Lisa McCracken, senior vice president of senior living research and development Ziegler, and is used here with permission.

The Centers for Medicare and Medicaid Services (CMS) has made important changes to the 5-Star Quality Rating System that could significantly affect providers’ ratings. These changes are effective immediately and can be reviewed on Nursing Home Compare. 

A preview of the reports using the newly revised rating system was available for advanced provider review on Feb. 13, 2015, according to BKD.

While no changes were made to the actual Quality Measure (QM) data collected, providers could see a significant change in their QM category rating -- and subsequently to their overall star rating -- due to the new calculation methodology. 

This also could lead providers to see a decline in their QM score even if there has been no actual decline in the quality of care provided.

Three changes have been made to the calculation methodology: the addition of 2 new quality measures to the existing 9 (out of 18 available), changes to the cutoff points for determination of each QM star level and changes to the staffing star category.

New Quality Measures

The new measures address short-stay and long-stay antipsychotic use.

  • The short-stay antipsychotic use QM will trigger if antipsychotic medication was not coded on the initial MDS in section N0410A but is coded on a subsequent assessment. The diagnoses of schizophrenia, Tourette’s syndrome or Huntington’s disease coded in Section I of the MDS will serve as exclusions for the triggering of the measure.
  • The long-stay antipsychotic use QM will trigger if any antipsychotic use is coded in section N0410A of the MDS unless schizophrenia, Tourette’s syndrome or Huntington’s disease is coded in Section I.

Cutoff Point Changes

The addition of the antipsychotic QMs used to calculate the QM star rating led to an increase in the number of points available. CMS reset the thresholds by increasing the number of points required to achieve a 5-star rating. The actual point system used to assign points to each QM category also was revised.

  • While facility-specific scores are not published by CMS, providers can contact the 5-Star Help Line (800.839.9290) for a breakdown of their overall QM points as well as the points assigned to each QM category; the contact information for the help line is located on the 5-Star Report. This information can be helpful in determining the actual QM categories that affected QM rating changes as well as the total number of points required to achieve the next star level. The help line has expanded its availability in February and March from 1 week to 2 weeks.  

Staffing Star Rating Changes

Previously, a 4-star staffing rating could be achieved if the data indicated both the RN staffing component and total staffing component were each assigned 3 stars. 

Under the new scoring rules, both the RN and total staffing component must be rated at the 3-star level or higher, and one of the categories must be rated at the 4-star level to achieve a 4-star staffing rating.

With these changes, CMS is continuing its attempts to improve quality of care. 

The addition of the antipsychotic medication quality measures works toward CMS’ goal to reduce overall antipsychotic use in the long-term care population and stresses its expectation that providers review and make gradual dose reductions as appropriate. 

Increasing the total number of points required to achieve a 5-star level quality measure rating encourages providers to make continuous progress toward quality improvement. 

Increased requirements to achieve the four-star staffing rating could improve the quality of care provided to the long-term care population.

Learn more.

This article was written by Martie Moore, chief nursing officer for Medline Industries Inc., and originally appeared in McKnight’s Long Term Care News. It is used here with permission.

My parents have a friend who's struggling with a foot ulceration from diabetes. Recently, I had a chance to learn more about what she goes through. While she has managed her diabetes fairly well, she did not understand how diabetes impacts her body. 

She bought and wore shoes that caused pressure on an affected foot. Because of her diabetes, she lost sensation and couldn't feel the damage to a foot until it was inflamed, infected or had an open area.

She sent me some photos and we discussed them over a conference call with her primary care physician. Together, we determined how best to care for the area. When I called to check on her, details about her foot and pain were varied and inconsistent. 

In working with the team that was caring for her, it became clear there was not a standard method of assessment for both the wound and her pain management.

We worked together to introduce the Pressure Ulcer Scale for Healing or PUSH tool. The PUSH tool was developed by the National Pressure Ulcer Advisory Panel as a method to monitor healing ulcers. It helped us in having a standardized tool with common language to determine how well she was healing.  

Utilizing a standardized tool for wound healing guides the plan of care and communication among those caring for her. It also helps the family become more comfortable and confident about the healing of her ulceration. 

When it comes to pain assessment, it's a little more difficult to establish a standardized process.  Because of a past insult to her brain, she had some impairment in her cognitive ability. When asked if she had pain, she would say “yes.” When asked to give pain a number, it would be a 2 (not much pain) or 10 (worst pain ever).

In working with her care team, we talked about what they were assessing instead of a number being assigned for pain management. Surprisingly, we learned that the number had no meaning to her. When we mapped out her behaviors, we saw patterns occurring around pain. She was alone in her room away from others when she was in pain. 

When ambulating, she grimaced and moaned. Utilizing OTC pain management tools, we were able to manage her pain by observation of nonverbal behaviors and a checklist of items to have done to manage pain on a consistent level.   

By utilizing both the wound healing tool and behavioral assessment, we were able to get her back to her favorite activities, including Wednesday Bingo. Most importantly, we were able to help address and heal her foot ulcer.  

I worked with a team of dedicated and caring individuals. What surprised me was the lack of standardized assessment available to them to utilize in her care. Without a standardized tool, care became fragmented. It was also confusing to understand wound response to treatment.   

Every day, I see how much we as caregivers must move toward reducing variation by utilizing evidenced based tools for both assessment and communication of care. 

While high profile breaches at Target, Home Depot, and Sony dominate the headlines, breaches at small businesses fly under the radar. Yet these disruptions are often more devastating, even to the point of business failure, according to CliftonLarsonAllen.

Churches and other organizations that never considered themselves targets are becoming victims of credit card fraud, automatic clearing house (ACH) fraud, and wire fraud. These crimes are often perpetrated from outside the country by attacking the online cash management features that banks provide their customers.

You can take steps to protect your entity, but before taking action, you must first understand and acknowledge this growing threat. The attacks fall into three main categories:

 

  • Theft of personal financial information.
  • Online banking malware (so-called corporate account take-over).
  • Ransomware attacks (the most common being CryptoLocker).

 

Theft of personal financial information

Organized crime groups (primarily in Russia, Eastern Europe, and China) have created a high demand for personal financial information, including name, address, social security number, driver’s license number, bank account number, and credit card details. 

Hackers steal this information then sell it to criminals who use it to commit various forms of identity theft. The more complete and associated to an individual, the more valuable the information is on a “wholesale” basis. Payroll databases, customer sales records, and supplier/accounts payable records are common targets for this type of attack.

This was the driving force behind the breaches at Target, Neiman Marcus, the University of Maryland, and many others. Indeed, as the price being paid to hackers escalates, smaller businesses are being targeted.

Online banking malware

Zeus, Citadel, Spyeye, and Gozi are just a few examples of the new breed of sophisticated online banking malware. 

Once a network is infected with this type of malware the online banking credentials (user ID, password, challenge questions) are harvested by the attacker, who then logs into the online banking server and executes fraudulent wires or ACH transactions. More sophisticated malware can bypass multifactor authentication tokens. This type of attack is often called corporate account takeover.

Malware code is often delivered via email, either by a file attached directly to the message, or more commonly, by use of a link to a rogue web page. 

In the latter case, the malware returns with the web page and installs itself on the victim’s computer. This type of attack has been dubbed “spear phishing” since often only one email is sent to the victim organization.

Spear phishing emails have improved significantly in their sophistication and effectiveness, and can be very difficult for users to identify as fraudulent. They often use carefully crafted scripts to entice the user to click the link. 

In some cases, the emails are even “spoofed,” that is, they are crafted to appear to come from someone inside the victim organization (e.g., the company president). 

In other cases, the emails are designed so they appear to come from a legitimate business or organization, such as UPS, American Express, PayPal, or the IRS. 

These spoofing tactics are designed to increase the likelihood that the recipient will act quickly, clicking on the link without much thought.

Ransomware

Ransomware is a malware that encrypts virtually all data and files that it can find, both on the local machine and on every network device that it can connect to. This renders the data unusable by the victim organization. 

Typically the hacker requests payment (the ransom) in exchange for decrypting the affected data. This is how the hacker hopes to make his money.

Having working backups that are regularly tested allows victims to wipe the affected machines clean and reinstall both systems and data. 

However, for companies with high reliance on technology, even the downtime required to wipe and reinstall can result in costly losses and reputational damage.

CryptoLocker is by far the most common ransomware deployed. CryptoLocker attacks are increasing rapidly because they are easy and effective. Such attacks rose from 7,000 in April 2014, to more than 15,000 in May. 

Kovter is a ransomware variant with an especially malicious tactic. It dumps a payload of child pornography, in addition to the encryption, to put more pressure on the victim to comply with the ransom demand.

Protecting your business

Preventing these attacks is no small task. It requires a multilayered approach. Organizations should consider each of these tactics.

Properly defend

  • Keep current on technical defensive measures such as firewalls, intrusion detection systems, and spam filters.
  • Keep up-to-date on the anti-virus software on each device, and complete regular scans to keep them clean.
  • Keep all network servers and PC workstations current with the latest security updates and patches.
  • Limit the number of PCs used to conduct online cash management. If possible, isolate them from the rest of the company network.
  • Encrypt sensitive data, such as intellectual property and personal financial information.
  • Utilize bank security tools for online cash management, including:

    • Multifactor authentication.
    • ACH blocks and filters.
    • Daily and individual transaction limits.
    • Wire call-back features.
    • Positive pay systems to reduce check fraud.

  • Make regular backups of key data and systems and store them in a secure, off-site location.
  • Monitor activity and balance online accounts daily.
  • Perform periodic vulnerability or penetration assessments to validate that controls believed to be in place are functioning as intended.

Relationships, communication, and training

  • Educate users to spot fake emails and to be wary of website links and file attachments.
  • Read and thoroughly understand your agreements with your bank related to online activity.
  • Identify the primary contact at your bank who will be your first call for help in the event of a breach.
  • Develop an incident response plan so users know who to contact immediately if they suspect malicious activity on their computer.
  • Establish a relationship with local law enforcement agencies that are familiar with online crimes.

This article was written by Mark Eich, principal, information security and is used here with permission. You can reach Mark via email mark.eich@CLAconnect.com or via phone: 612-397-3128.

ICD-10-CM is a major initiative for Post-Acute Care (PAC) organizations. 

A new paper from HealthStream discusses the positive outcomes, illuminate the major changes PAC organizations can expect, and address the new opportunities ICD-10 will present for delivering and tracking patient care.

Industry chatter is at an all-time high as embattled legislators and healthcare policymakers once again negotiate the start date for the transition from the International Classification of Diseases, 9th revision (ICD-9) to ICD-10 codes. 

For post-acute care (PAC) organizations, however, the show must go on. With a new deadline of October 1, 2015, now is not the time to stall ICD-10 planning. ICD-10 ushers in new opportunities for healthcare organizations to document and code with greater accuracy and specificity.

Ultimately, the goal of ICD-10 is to improve care quality and compress healthcare spending.

How Is ICD-10 Playing Out in the Post-Acute Care World?

Post-acute care (PAC) organizations are at varying states of readiness. With so much ado about ICD-10’s impact on acute care organizations, the post-acute care side of the story hasn’t been spoken loudly enough. This is due in part to PAC providers’ somewhat hands-off approach under ICD-9.

Many in post-acute care have squeaked by with ICD-9 cheat sheets, scaled back coding policies, and non-credentialed staff. Some PAC providers even dismiss ICD-10 as a “coding issue.”

With ICD-10-CM (Clinical Modification), however, this approach will not suffice. To start, the increase in codes is substantial. There are more than 13,000 diagnostic codes in ICD-9-CM, in Volumes 1 and 2. In ICD-10-CM, this number skyrockets to more than 70,000 diagnostic codes. 

These changes apply to all post-acute care organizations including skilled nursing facilities (SNFs), long-term acute care (LTAC) organizations, home health agencies, hospice, and others.

This paper includes: 

  • Why It’s Time for ICD-10.
  • How ICD-10-CM Impacts 5 Major Areas in Post-Acute Care Settings.
  • Big Documentation Changes Ahead.
  • The New Wild World of Codes.
  • Breaking ICD-10-CM Coding Myths.
  • Reimbursement and ICD-10-CM.
  • Quality Reporting Under ICD-10-CM.

This free course from Medline is an overview of abuse, including the Centers for Medicare and Medicaid Services (CMS) definition of abuse. 

The different types of abuse and examples of each will be explored, as well as recognition and reporting responsibilities.

This training is appropriate for all team members in long term and post-acute care. This course does not replace or supersede facility policy, state and federal regulations.

Learning Objectives

  • Understand and define abuse.
  • Recognize and describe the different types of abuse.
  • Identify reporting responsibilities and procedure.

Background

Cross Keys Village (“Cross Keys”) is a not-for-profit continuing care retirement community providing residential, health care and other supportive services to seniors in South Central Pennsylvania. 

It is located on approximately 250 acres in New Oxford, Pennsylvania. Cross Keys is the ninth largest single-site, not-for-profit CCRC in the U.S. and currently consists of 444 independent living units (apartments, cottages and country homes), 91 personal care units and 270 skilled nursing beds. 

Cross Keys was founded in 1908 and is affiliated with the Southern District of the Pennsylvania Church of the Brethren. It is currently rated “A-” by Standard & Poor’s.

Challenge

Coming out of an extensive master planning process, Cross Keys identified a range of capital investment needs and opportunities across its continuum. 

However, given the magnitude of project costs and varied implications for net revenue generation, Cross Keys determined that it would need to further refine its capital investment needs; it wanted to strike a balance between its highest priority needs and maximize additional revenue. 

Working with its project planning team, including SFCS, Greenbrier Development and HJ Sims, Cross Keys ultimately decided to undertake a significant renewal of its health center facilities, particularly in skilled nursing and memory support, and to build new cottages.

Cross Keys faced a number of challenges in creating its project financing strategy. First, it sought to preserve its strong financial profile by limiting capital investment to its highest priority needs. Second, Cross Keys sought to minimize the overall cost of financing (up-front financing costs, interest cost and aggregate debt service). Third, the projects were to be phased over 3 years, consisting of multiple components and different design-development scopes. 

Cross Keys also sought to begin construction before year-end 2014. 

Finally, given the phased nature of design, development and construction, the exact amount of total project costs would not be known for 12-18 months. 

Accordingly, cost minimization, flexibility and speed to complete initial financing were the key objectives in structuring the financing.

Execution

Recognizing the multiple challenges, Sims worked with Cross Keys Management and its existing bank, PNC, to explore financing alternatives for the project along with its integration with Cross Keys’ existing debt, comprised of tax-exempt variable rate demand bonds (“VRDBs”) backed by a letter of credit (“LOC”) from PNC. 

Financing options focused on the use of interim financing, to be followed by a subsequent take-out as permanent financing, once final project plans and costs are known.

However, multiple structuring options were considered including: 

 

  • The desired combination of Cross Keys “equity,” whether up-front or via ongoing cash flow, to be combined with interim bank debt.
  • The optimum amount of financing to comprise the initial phase of interim financing, seeking to balance the amount of the bank credit commitment with the cost of financing.
  • The use (and all-in cost) of taxable vs. tax-exempt debt.

 

The financing was ultimately structured as a $10 million short-term taxable revolving line of credit from PNC Bank, with proceeds used to fund the initial phase cottages (19 units) along with the initial costs of the memory support project and additions to selected common areas. Funds are to be drawn by Cross Keys for project costs, as incurred, at a variable rate of interest tied to 30 day LIBOR plus a credit spread. 

The line may be repaid at par, and redrawn by Cross Keys, during its term.

Results

With the assistance of Sims and the project-financing team, Cross Keys was successful in completing the financing in late November 2014. Cross Keys achieved its various objectives with a very attractive financing structure, leveraging its credit strength and banking relationship with PNC. 

Highlights include: 

 

  • Having committed funding for the first phase of its capital projects, together with confidence in the availability of additional capital when needed over the next couple of years. 
  • A very low all-in cost of financing (approximately 1.25% floating rate), using a draw-down feature along low total all-in financing costs.
  • Significant future flexibility for financing of subsequent phases of its capital projects.

 

Sims served as Structuring Agent for the financing, and this was the fifth financing transaction completed for Cross Keys by Jim Bodine over a 20 year time period. For more information, please contact Jim Bodine.

GlynnDevins is continuing to share informative video presentations on interesting and relevant content that was shared on the Ignite stage at the national LeadingAge Annual Meeting in Nashville in October 2014. 

This article features the third and fourth videos. The first and second videos were featured in an earlier article. 

It’s time to recognize that, no matter what industry you work in, senior living included, your customers are online, and you need to provide the best possible experience to gain and maintain their interest. 

GlynnDevins’ director of digital user experience and process, Carrie Peterson, told her audience at the LeadingAge Annual Conference in Nashville that the experience a user has on a website can lead to a stronger prospect or to a missed opportunity. 

Which would you rather have?

Watch the video to hear Carrie discuss ways you can make your community’s website stand out to senior consumers.

The phenomenon of social media isn’t slowing down anytime soon. Organizations today simply can’t ignore the impact it can have on a business, including a senior living community. At the LeadingAge Annual Conference in Nashville this past October, GlynnDevins’ Associate Director of Public Relations, Brandi Towns, shared how social media can be an inexpensive and very effective way to show off your community and reach leads, prospects and influencers.

Watch the video to hear Brandi talk about senior living communities across the country that have displayed a great understanding of the socialsphere.

For many marketers in all industries, a strong Facebook presence is a critical component of not just a social media strategy, but a marketing strategy as a whole. 

However, in the early days of Facebook, senior citizens (65+ for the purposes of this post) lagged behind dramatically in usage compared to other age groups, according to Martino and Binzer and Bluespire Marketing.

However, that line of thinking has a very short shelf life according to recent findings by Pew Research Center. Seniors aged 65+ saw an 11% increase in users, from 45% of online adults in 2013 to 56% in 2014. 

While adoption in other social media applications such as Twitter, Instagram, LinkedIn, and Pinterest are still low, all saw an increase in adoption of at least 5% from 2013 to 2014, with Pinterest seeing the largest jump.

This is encouraging, but daunting, data for senior living communities who have avoided having a strong social media presence. 

On one hand, this data confirms that an investment in social media would be worthwhile. On the other, it is another component to maintain for communities who are already strapped for resources.

Most importantly, despite the increase in Facebook users, there is far more senior living communities that need to know about the social media platform and promoting communities featuring the use of Facebook.

As senior housing communities know, the Fair Housing Act (FHA) still applies to senior living communities.

While these communities have an exception in not having to rent to people with children, they still need to abide by the diversity provisions for people -- or human models as outlined in the FHA -- used in advertising. 

Not adhering to these laws can result in lawsuits and charges of discrimination. You can get a great overview of the specifics of the FHA on the Fair Housing Blog.

Before your residents can appear in any advertising, each identifiable person that will be shown must sign a model release. 

This goes for pictures taken at events hosted by your community. If your community does not have a model release form, many templates can be found online or our senior living experts can help your community put one together.

Secondly, as outlined by Nadeen Green at Fair Housing Blog, “Be sure that the folks who are your models are representative of the population in your metro-area. Not at the community itself, not in the neighborhood or section of town, but your metro-area.” 

To make sure you comply with these diversity requirements, make sure you contact your legal counsel.

Finally, it is important to note that all of these requirements apply to social media, as it is currently considered a form of advertising. 

While prospects are joining the ranks of Facebook quickly, communities must ensure they comply with all laws and requirements before making social media a part of your marketing plan. You can learn more from the questions posed in this Fair Housing Blog recording.

This article was written by Fran Palma, and is used here with permission.

Organizations that have paid rent, royalties, dividends, interest, payments for health care, or non-employee compensation in the past year may be required to complete and file IRS Form 1099. 

But almost half of the 500 participants in a CliftonLarsonAllen webinar called, “How to Comply With 1099 Reporting Requirements,” said they do not think they have been in full compliance with 1099 filing requirements in the past.

“Determining who should receive the form and what to include in the filing can be complicated,” says Karen A. Gries, a principal working with nonprofits on tax compliance and consulting. “Most organizations say they have policies and procedures in place related to 1099 compliance, but they may not cover all the bases.”

Learn who, how, and when to file.

Download our webinar recording and presentation slides to learn how you can meet IRS deadlines and address the unique filing requirements for tax-exempt organizations.

  • Who must file the 1099
  • The specific 1098 or 1099 form to file
  • How to gather vendor information
  • Box-by-box instructions on what should be included
  • Who must pay backup withholding
  • Who must file electronically
  • Penalties for noncompliance

The one-hour online presentation is hosted by Gries and Judy Enders, a consulting manager with CliftonLarsonAllen.

Pages

Subscribe to Corporate Partners