Client Background

A large publicly funded nursing facility in San Francisco. It plays a crucial role in the health care safety net, primarily serving socioeconomically disadvantaged residents. The facility accounts for more than a third of all skilled nursing beds in the city, with Medicaid and Medicare funding nearly all resident care.

The Situation

In April 2022, the facility faced a severe crisis when it was decertified for failing to meet Medicare and Medicaid conditions of participation, which threatened its closure and the displacement of nearly 700 residents.

During a mock survey commissioned shortly after decertification, the facility was cited for 101 regulatory deficiencies, which required immediate and comprehensive resolution to avoid jeopardizing its path to recertification.

The hospital also struggled with leadership, operational, and cultural challenges, including unclear initiative ownership, unreliable processes, and lack of accountability.

The Solution & Results

Moss Adams was enlisted to assist in executing the requirements of a settlement agreement for recertification. Moss Adams implemented their strategy acceleration framework, which involved embedding with facility leaders and staff to drive rapid performance improvement. Key actions included:

• Overseeing the execution of action plans with over 1,000 milestones to address deficiencies
• Establishing a tiered visibility, accountability, and reporting structure from facility leadership to the frontlines of the organization and vice-versa
• Improving organizational focus and continuity despite leadership turnover
• Implementing data-driven problem-solving at the frontline
• Facilitating cross-disciplinary teams to address regulatory issues
• Enhancing collaboration and empowerment across teams, leading to high-reliability processes
• Utilizing Plan-Do-Study-Act (PDSA) methods for long-term sustainability

With these and other key interventions, within a one-year span the facility:

• Achieved a 100% reduction in substandard care tags
• Realized a 59% reduction in total regulatory tags
• Attained an 85% reduction in the overall scope and severity of tags from a November 2022 Centers for Medicare & Medicaid Services (CMS) monitoring survey to the November 2023 recertification survey

As a direct result of the organization-wide improvements, the facility was recertified for Medicaid in August 2023 with 95% of funding restored. It was fully recertified in both Medicaid and Medicare by June 2024. The facility was able to secure its long-term future, aiming to not only maintain its gains, but to excel as a leading skilled nursing facility.

We’re Here to Help

For more information on how our strategy acceleration and organizational change management framework can help your organization overcome significant challenges, please contact your Moss Adams professional.

Additional Resources

• Health Care Consulting Services
• Lean Health Care Services