NR 588 Week 2 Partner Analysis Example

Partner Analysis: A 120-Bed Skilled Nursing Facility Owned by a Regional Chain, Read Through Its Money, the Numbers It Reports Upward and Where Its Interests Part From the Hospital's

Student Name

College of Nursing, Chamberlain University

NR 588: Advanced Nursing Leadership Across Complex Systems

Instructor Name

Month Day, Year

Partner Analysis: A 120-Bed Skilled Nursing Facility Owned by a Regional Chain, Read Through Its Money, the Numbers It Reports Upward and Where Its Interests Part From the Hospital's

The Stated Mission

Maple Grove's website describes its mission as providing "compassionate rehabilitation and long-term care that helps residents return home or live well." The mission tells us what the facility wants to be known for. It does not tell us how it is paid, who it answers to or what it would lose by working with us.

Money Before Mission

Maple Grove has 120 beds. From the chain's public filings and the facility's cost report, about 82% of beds are occupied on an average day. Roughly a quarter of occupied beds are Medicare skilled stays, paid at a daily rate set by Medicare's patient-driven payment model, which pays more for patients with higher clinical and therapy needs. About half are Medicaid long-term care residents, paid at a much lower daily rate set by the state. The rest are Medicare Advantage and private pay.

Medicare skilled days are the facility's most profitable. Every short-stay patient who completes a rehabilitation stay brings revenue that Medicaid days do not. A patient readmitted to the hospital usually ends that stay; if they return, a new stay begins, but many do not return.

Medicare also withholds 2% of the facility's Medicare payments under the skilled nursing facility value-based purchasing program and pays back a share based on its readmission performance. For Maple Grove, that withheld amount is in the tens of thousands of dollars a year.

Labor is the largest cost. The facility uses agency nurses on nights, which costs more and makes consistent practice harder.

The Numbers It Reports Upward

The administrator reports to the chain's regional vice president of operations each month. From conversations with the facility's director of nursing and the chain's public materials, the numbers that travel upward are:

Occupancy and the share of Medicare skilled days.

Labor cost per patient day, including agency spending.

The facility's star rating on Medicare's public comparison website.

Its readmission measure under the value-based purchasing program.

Referral volume from each hospital.

Any proposal from us has to move one of these numbers, or at least not hurt one, to survive the administrator's next monthly report.

Who Owns the Service Line

At Maple Grove, short-stay rehabilitation is run day to day by the director of nursing, with an admissions director who decides which hospital referrals to accept. The facility's medical director, a physician who visits twice a week, oversees care but does not control staffing. Any arrangement touching admissions, night nursing or transfers needs the administrator's approval and the director of nursing's cooperation.

Timing

The chain's fiscal year runs January to December, and budgets are set in October. Our hospital's fiscal year runs July to June. A request that needs Maple Grove to spend money in 2027 must reach the administrator before October 2026.

Where Interests Genuinely Part

Interests align on readmissions in general: both organizations lose money and reputation when patients bounce back.

They part in four places.

Acceptance. We want Maple Grove to accept patients faster, including on weekends and late in the day. Maple Grove prefers to admit patients it can staff for and avoids late admissions when only agency nurses are on.

Acuity. We want it to take more complex patients, such as those on intravenous antibiotics. Higher acuity raises its payment but also its risk of readmission, which counts against it.

Night transfers. A night nurse with an unfamiliar patient who sends the patient to the emergency department is protected from blame. Keeping the patient and calling a clinician takes time and carries risk for the facility.

Data. Sharing transfer data with us helps both sides, but it also shows a large customer where the facility falls short.

Rahman et al. (2013) found that patients discharged to facilities with strong referral links to a hospital had lower readmission rates. The link helps both, but it gives the hospital influence the facility may resist.

What the Facility's Staff Say

I spoke with Maple Grove's director of nursing twice, once at the facility and once by phone. Three points came up without prompting: patients arriving late on Friday with incomplete medication lists, night agency nurses who do not know the residents and hospital discharge summaries that arrive after the patient. Each is a cost the facility already carries because of how we discharge. Mor et al. (2010) found that readmissions from nursing facilities often follow transfers at night and at weekends, which matches the director's account. The director also said the facility would welcome help at night but cannot pay for clinicians it does not employ.

What Has Worked Elsewhere

Programs that give facility nurses structured tools for recognizing and communicating a change in condition have reduced hospital transfers in published evaluations (Ouslander et al., 2011). That suggests the facility's night nurses, not its leadership's goodwill, are where any arrangement will succeed or fail.

Their Alternatives to Us

Maple Grove takes referrals from two other hospitals in the region and from Medicare Advantage plans. We send it about 38% of its short-stay admissions, so we matter, but it does not depend on us. If our demands are too costly, it can take more patients from the other hospitals, and its occupancy would barely change. Our alternatives are three other facilities within 20 miles, two with lower star ratings.

What the Partner Loses by Saying Yes

Staff time on calls and documentation, at night when it has least to spare. Control over its own transfer decisions. Some protection from blame. Data it would rather keep internal. A useful analysis says so, because the administrator will.

Hedging Where the Course May Differ

Our course may introduce a particular stakeholder mapping tool later. This analysis uses the partner's money, reporting and alternatives because those are what an administrator will weigh, and can be reorganized into any framework the section requires.

Sources and Their Limits

Everything here should be checked with the administrator before it is used in a proposal, since an outsider's reading of another organization's finances is easy to get wrong.

Facility figures come from its public cost report, Medicare's comparison website and conversations with its director of nursing. The chain's internal targets are inferred, not seen.

References

Mor, V., Intrator, O., Feng, Z., & Grabowski, D. C. (2010). The revolving door of rehospitalization from skilled nursing facilities. Health Affairs, 29(1), 57-64. https://doi.org/10.1377/hlthaff.2009.0629

Ouslander, J. G., Lamb, G., Tappen, R., Herndon, L., Diaz, S., Roos, B. A., Grabowski, D. C., & Bonner, A. (2011). Interventions to reduce hospitalizations from nursing homes: Evaluation of the INTERACT II collaborative quality improvement project. Journal of the American Geriatrics Society, 59(4), 745-753. https://doi.org/10.1111/j.1532-5415.2011.03333.x

Rahman, M., Foster, A. D., Grabowski, D. C., Zinn, J. S., & Mor, V. (2013). Effect of hospital-SNF referral linkages on rehospitalization. Health Services Research, 48(6, Pt. 1), 1898-1919. https://doi.org/10.1111/1475-6773.12112