Derek Prince, the CEO of HMG Healthcare, has been proactive in launching new initiatives to improve staffing within his organization. While celebrating successes in these areas, Prince remains acutely aware of the looming crisis posed by the federal minimum staffing mandate. This mandate presents significant challenges for nursing homes across Texas, exacerbated by long-standing funding issues. As a board member of the Texas Health Care Association, Prince joined forces with the American Health Care Association (AHCA) in a lawsuit to overturn the staffing mandate.
In this detailed discussion, Prince shares insights on HMG Healthcare’s achievements, nursing homes' challenges, and his future strategic priorities.
Why Texas Is a Battleground
Texas has historically struggled with funding issues that directly impact staffing levels in nursing homes. Prince notes that the state ranks poorly in staffing metrics nationwide. This issue is compounded by the new federal staffing rule, which requires skilled nursing facilities to meet stringent minimum staffing levels. According to Prince, the state faces a critical shortage of certified nurse aides (CNAs) and registered nurses (RNs), threatening the closure of many facilities and disrupting care for older populations.
“The quality that Texas provides, given the amount of resources, is commendable. But you can’t have great staffing numbers without the funding,” says Prince. He highlights that two-thirds of facilities in Texas do not meet the new requirements, necessitating an additional 9,000 CNAs and nearly 4,000 RNs.
Medicaid Recertification Delays
One of the significant challenges HMG Healthcare has faced is the delay in Medicaid recertification, which impacts cash flow. The state’s inability to process applications promptly has put severe financial strain on facilities. This issue is not unique to HMG but affects many providers across Texas and possibly beyond.
“Our biggest challenge comes from the Medicaid recertification delays, which severely burden our cash flow,” Prince explains.
Achievements Amidst Regulatory Volatility
Despite these challenges, HMG Healthcare has achieved notable successes. The organization has completed two deficiency-free surveys, created HMG University to train clinical workers, and reduced the length of stay at its facilities.
Prince is particularly proud of HMG University, an educational institution designed to generate clinical workers internally. Fifty-seven students are enrolled in various programs, including CNA to LVN and LVN to RN transitions. This initiative is part of HMG’s broader strategy to improve recruitment and retention through education and training.
Enhancing Recruitment and Retention
Prince’s top priority for 2024 is to improve labor practices and support team members as labor shortages continue. HMG is sharpening its focus on onboarding processes, training, and continuing education units. The goal is to create a supportive environment that attracts and retains top talent.
“When you walk into my office, a big neon sign says, ‘Take Care of People.’ This applies to our patient population and, importantly, to our team members,” says Prince.
Innovative Workforce Initiatives
In addition to HMG University, the organization has launched an in-house staffing agency to address labor shortages. This initiative has been highly successful, ensuring staffing needs are met across HMG’s 37 post-acute care facilities in Texas and Kansas. Moreover, HMG has built in-house dialysis clinics in partnership with DaVita at two campuses. This service improves the quality of life for residents with end-stage renal disease and serves the community.
HMG is also exploring innovative immigration arrangements with local universities to bolster its workforce. The aim is to tap into the pool of nursing students already in the U.S., provide them with exposure to the nursing profession, and potentially recruit them into the workforce.
Challenges with Survey Processes
The survey process has become increasingly punitive, with higher immediate jeopardies and civil monetary penalties (CMPs) across Texas. Prince argues that the focus has shifted away from quality improvement towards a purely punitive approach, which adds stress to already overburdened staff.
“The survey teams now focus entirely on penalties, without quality improvement or assurance. This needs to change to support better care,” says Prince.
Medicare Advantage and Managed Care
HMG has a significant portion of its patient population enrolled in managed care Medicare Advantage programs, which presents its challenges. Increased paperwork and audits necessitate stringent compliance and operational procedures to ensure timely compensation for services provided.
HMG has responded by streamlining its admissions and billing processes, ensuring that all patient care and documentation are meticulously managed.
Value-Based Care Initiatives
HMG also focuses on value-based care, aiming to reduce hospitalizations and improve quality outcomes through proactive care models. One significant initiative is the I-SNP (Institutional Special Needs Plan), which is provider-owned and emphasizes proactive care to sustain quality outcomes and reduce hospital visits.
Conclusion
Derek Prince’s leadership at HMG Healthcare exemplifies a proactive and innovative approach to overcoming the numerous challenges facing the nursing home sector. By focusing on improving staffing, supporting team members, and navigating regulatory and financial hurdles, Prince is committed to enhancing the quality of care for residents. As the sector continues to evolve, HMG Healthcare’s initiatives serve as a model for other providers aiming to improve the quality of care in nursing homes.
For more insights from Derek Prince and to stay updated on developments in nursing home care, subscribe to the RETHINK podcast via Apple Podcasts, Google Podcasts, or SoundCloud.
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