Springfield, Ill.—Good morning, ProviderNation. Illinois’ official state insect is the monarch butterfly. But, hanging with the fine folks of the Illinois Health Care Association last month for their inaugural future leaders program, I was struck not by their fluttering, regal beauty (although Illinois Health Care Association board President John Vrba is the very picture of one who hums on gossamer wings) but by their ant-ness.
You’ll recall from your Aesop that the sturdy ants had the last laugh when the frivolous grasshopper—who had mocked the ants for working hard during the summer—found his own frigid nose pressed to the glass as the bleak winter descended.
Illinois’ winters are no fun for anyone, and this year’s version hasn’t been made any better by the political permafrost that has left the state without a budget and teetering on the brink of something like collapse. But providers here, apparently, have accustomed themselves to the long, hungry winters.
‘Tighten Your Belt Up’
“You live within your means,” says Josh Matthis, assistant administrator at Evergreen Nursing and Rehabilitation in Effingham. “You tighten your belt up, and you give the care. We really haven’t had to do without. If we need it for the resident, we will get it.”
In part, that’s because Matthis—like many of the Illinois providers I talked to—have learned to adjust their business practices. Nationally, most providers rely on Medicaid for nearly two-thirds of their income. That just doesn’t seem to be true here in Illinois. Providers I talked with averaged between a quarter and one-third Medicaid for their census.
Never mind the current budget apocalypse: from an Illinoisan’s point of view, the state’s Medicaid payments—and timeliness—didn’t have to go too far before they hit rock bottom.
“They are behind, and you’ve just gotten used to trying to operate within that,” Matthis says. “Because that’s become the norm.”
That kind of grit is essential—and inspiring—says Dave Voepel, executive director of the Illinois Health Care Association.
“I continue to be amazed at the quality of services and the fortitude our members have in the wake of this budget crisis and in a state that has such a low reimbursement rate,” he says. “We continue to impress upon those in state government that long term care must have more dollars to continue to provide quality care.”
Indeed, it’s a source of pride to many Illinoisans here that they offer top-quality care even when a resident’s money runs out (or the state’s money runs late).
‘Does The Resident Need It?’
“I don’t make our department heads strain under budgets,” says Molly Carpenter, the administrator of Imboden Creek Living Center in Decatur. “The question is, does the resident need it? Okay, then, how do we meet that need while still being good stewards of our resources?”
That doesn’t mean that providers are in grasshopper mode, though. Carpenter, for instance, spends most of her days scrubbing every single data point in her building, making sure that “we’re capturing everything we’re doing from a care perspective” so that they can maximize their resources.
Perhaps it’s ironic, but the famine years here in Illinois have given many providers a kind of perverse expertise in minimizing cost while not sacrificing value.
A Delicate Balance
Love Dave, the administrator and owner of Elmhurst Extended Care in a tony, western suburb of Chicago, has created his own to-do list on the topic: Everything from hiring a full-time purchaser (“the cost of the salary pays for itself, almost immediately”) to buying the more expensive gloves (“when we have cheap gloves, you automatically lose a certain amount in a box. We, essentially, save money because our use is going down.”)
“There’s got to be a balance between making money and offering good care,” he says.
The key, Dave says, is to be mindful always of the coming winter. Things that may seem expensive now aren’t nearly so dear as when you find out you really, really need them, he says. For instance:
“Taxes in Illinois are incredibly high. So if you make a profit, your taxes are high,” he says. “Quarterly, we look at where our taxes are going to be, and we try to put it back in the building. I’d rather spend money on the building than give it to the government. Putting money into building repairs is not only great for the residents, it’ll essentially save you money.”
Dave and Elmhurst Extended have also thrived by bringing it all home, he says.
“We internalize all of our services,” he says. “A lot of places contract out for therapy or kitchen, and they actually share their revenue with the contractors. It takes a lot of work to get it going, but once you have someone in place, it works a lot better for the residents because they have the same therapist, they have consistently good food.”
Take, for example, the (initially, very expensive) chemo/dialysis services Elmhurst Extended offers its residents.
“It’s really nice for our residents because it improves the quality of their life,” he says. “If we don’t have it, they have to go in and out of the building three times a week. They miss meals, they miss activities, and it’s just disruptive. We don’t have to turn beds over as quickly. They’re actually getting healthier, quicker, because they’re not missing their meals, they’re not missing their therapy, they’re not missing their meds.”
That, in turn, pays its own dividends, Dave says.
“That’s one of the best things about an internalized model. You can drive quality and show people that they’re welcome to come back,” he says. “They don’t mind staying long-term, because they trust us.”
Ole Aesop couldn’t have said it better himself.