Cathedral Rock: A Call to Action for Us All

This week, five Cathedral Rock nursing homes pleaded guilty to felony health care fraud for failure to provide adequate care to Medicare and Medicaid beneficiaries. In the criminal prosecution and civil settlement agreements, the US Attorney’s Office of the Eastern District of Missouri cited Cathedral Rock’s failure to perform essential patient-care responsibilities like wound care and medication administration. The five facilities have since been closed. Cathedral Rock had been fined $1.6+ million. The two former employees of Cathedral Rock who filed the qui tam complaint will be rewarded $94,200 from the civil settlement.

I’ve been wondering how Cathedral Rock – or any organization in long-term care -- could find itself in this position, losing so much for what appears to be flagrant violations of standards of care and an alarming breakdown in their systems of care delivery. Like many organizations in post-acute care, Cathedral Rock’s senior management appears to be a group of highly experienced individuals with excellent credentials. Their company mission statement is both moving and laudable: “Integrity first, service above self, and excellence in everything we do.”

How can an organization that has every good intention of providing a high quality of care and service admit in plea agreements that “medical records were falsified and a ‘charting party’ occurred at Springplace to fill in medical records so that it appeared that all medication had been properly given, regardless of whether the medication was actually given or not.”?  Why is it that in highly regulated environments, people feel the need to build Potemkin villages—impressive, showy facades designed to mask undesirable facts and look good to the powers that be? Sadly and way too often, behind those facades are fallen heroes, broken promises, and downright bad practices that do harm. I’ll wager that this was not how it all started at Cathedral Rock, but this is clearly where it ended for five of its facilities.

So, what’s the learning here? How do long-term care facilities problem solve and manage in a way that broadly engenders an understanding that the company does well by doing good?

I see quality improvement coupled with compliance management as the answer. Today, Cathedral Rock is faced with the daunting challenge of rapidly implementing a comprehensive compliance program, but compliance is just part of the picture. Without a focus on improving performance in quality of life and care, without developing the systems and skills throughout the company to manage and continuously improve quality of life and care, Cathedral Rock, like so many others, will flounder on the edge of excellence and fail to fulfill its mission of integrity, service, and excellence -- over and over and over again.

And later this week…

...I saw David Zimmerman, President of the Long-Term Care Institute. He shared an astute observation with me about the dual challenges faced today by long-term care organizations. He pointed to their need to care for higher acuity patients coming out of hospitals, as well as for younger, more psychosocially challenging residents who are referred to them in growing numbers -- and the need for adaptation at every level to this new environment.

Charles Darwin couldn’t have said it any better.

In the environment David described it’s paramount that long-term care companies adapt their performance in both quality and compliance. In part, this means improving the tools and management systems that we use to assess, triage, action plan, and manage to meet complex needs at both ends of the spectrum – and every need in-between.

And so to literally practice what I preach, I am leading my company in taking stock of the suite of tools and management systems we use offer long-term healthcare companies. I plan to refine them with an eye toward organizational performance adaptation. To do this, I am pulling together a team of experts to work with me as a think tank with a goal of taking a critical look at the current landscape of long-term care compliance and identifying what’s needed to fill the gaps and refine my tools and systems. Clearly, it isn’t good enough to stand still or to chase after the latest regulatory focus anymore.

Cathedral Rock is a call to all of us in long-term care to do better. I wish Cathedral Rock much success in their efforts because I know their achievement will affect the lives of the many people who live and work in the facilities they manage. And there will be everything to celebrate in that.