Background

Sentara Healthcare (Sentara) is an integrated health care system headquartered in Norfolk, Virginia. The system includes 12 hospitals, a health plan, two Program of All-inclusive Care for the Elderly (PACE) locations, nine skilled nursing facilities (SNFs), one assisted living facility, a home health agency, hospice services, palliative care, medical transport, two pharmacies, a long-term acute care hospital (LTACH), and an inpatient rehabilitation facility (IRF). Sentara had been experiencing leadership instability, regulatory inconsistency, occupancy declines, and staffing issues. It was also facing losses and other operational challenges in the SNFs that were part of its long-term care division (Sentara Life Care). In addition, Sentara was trying to determine how the senior care division would be optimally structured going forward. To assist with these efforts, Health Dimensions Group (HDG) was engaged to support a myriad of operational and strategic considerations.

Solution

Over the past several years, HDG has supported Sentara with services ranging from the provision of interim executive leadership for the Sentara senior care division to optimizing performance of the skilled nursing communities, ultimately positioning these assets for divestiture to a regional long-term care owner/operator. HDG secured an interim vice president of operations officer for Sentara Life Care, who oversaw all aspects of this division during the 26-month assignment, as well as an interim nurse executive for Sentara Life Care. In addition, HDG produced an initial in-depth assessment of and recommendations for Sentara’s existing SNFs, and overall post-acute services, in order to make essential operational and strategic decisions for the current and future state. The initial assessment included the following:

  1. National trends affecting health systems relative to post-acute care (PAC).
  2. State of Virginia assessment overview of payor information, SNF provider trends regarding per patient day (PPD) benchmarking, and health system SNF provider trends regarding ownership, partnership, and management.
  3. Regional competitor overview of large East Coast health system providers and trends regarding ownership, partnership, and management.
  4. Sentara assessment of each market to determine correct bed distribution to meet resident needs, benchmarking of key financial indicators, and PPD ratios.
  5. Repositioning options for bed-size distribution and recommendations for investment/divestiture.

HDG was integral in establishing several key initiatives that assisted Sentara in the eventual divestiture of the skilled nursing portfolio

Following the initial assessment, HDG was engaged to provide oversight/wrap-around services to ensure optimal operational performance while Sentara worked through a strategic planning process. Those oversight services included a focus on:

  • Occupancy development
  • Revenue optimization
  • Clinical/regulatory support
  • Workforce recruitment support/agency elimination
  • Revenue cycle support
  • Electronic medical record (EMR) system optimization
  • Centers for Medicare & Medicaid Services (CMS) Mega Rule
  • Patient-Driven Payment Model (PDPM) post-implementation support and ongoing audits
  • Therapy Part B revenue optimization
  • Divestiture support and assistance
  • Mock survey
  • COVID-19 plans and response

Results

Through the provision of interim leadership, oversight of day-to-day operations, and support of broader strategic planning efforts, HDG was integral in establishing several key initiatives that assisted Sentara in the eventual divestiture of the skilled nursing portfolio to another regional owner/operator.

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