Multi-Facility Turnaround Delivering Census Growth, CMS Star Rating Improvement, and Financial Recovery
The Challenge: Declining Census, Medicaid Revenue Losses, and Low CMS Ratings
In early 2024, a regional post-acute care operator engaged Everest Management Solutions to lead the operational turnaround of a five-facility skilled nursing portfolio in the Midwest. The portfolio faced severe financial pressure, staffing instability, and declining CMS quality ratings, threatening both sustainability and regulatory standing.
At the time of engagement, the portfolio experienced:
- A declining average daily census (ADC) of 398.
- Medicaid reimbursement reductions of -8.8% (early 2024) and -7.7% (July 2024) due to prior management’s reporting errors, resulting in $2.04 million in lost revenue.
- Staffing challenges driven by below-market wages, leading to high agency dependence.
- Deferred maintenance and closed units, including a 17-bed unit at one facility due to plumbing issues.
These combined factors jeopardized clinical quality, staff retention, and financial viability.
Our Approach: Stabilization, Census Recovery, and Quality Improvement
Everest implemented a comprehensive operational stabilization and growth plan focused on census recovery, financial optimization, and quality improvement.
The team began by deploying experienced leaders to reestablish accountability and align each facility around clear census, quality, and financial goals. Everest reopened closed units, strengthened referral networks, and standardized admissions processes to drive census growth and revenue recovery.
To address staffing challenges, Everest completed a comprehensive market wage analysis, implemented targeted recruitment initiatives, and prioritized team morale and engagement to support and retain existing staff.
At the same time, Everest introduced financial controls and efficiency measures to eliminate waste, correct reporting errors, and reinvest savings into staff and care improvements.
Results: Portfolio-Wide Census Growth, Revenue Recovery, and CMS Star Improvement
Within one year of Everest’s engagement, the portfolio achieved measurable operational and financial transformation:
- Census increased from 398 to 436, a 9.5% portfolio-wide growth.
- Medicaid rates improved by 5.5%, reversing previous reimbursement losses.
- Two facilities gained additional private-room reimbursement approvals.
Each facility implemented a new wage package, resulting in a 14.5% year-over-year increase in labor spend. While this represented a higher investment, it made the communities far more competitive in hiring and retention, allowing them to reduce agency dependence and staff appropriately for resident needs.
The result was a more consistent and higher-quality care team, which directly contributed to a 33% year-over-year decrease in rehospitalization rates and improved quality measures across the portfolio.
CMS Five-Star Quality Improvements:
- Facility D: Increased from 1-star to 2-star overall, achieving 5-star in Quality Measures.
- Facility E: Increased from 1-star to 2-star overall (pending 3-star upgrade).
- Facility B: Maintained 1-star overall but improved to 4-star in Quality.
- Facilities A and C: Maintained operational stability with 2025 improvement plans underway.
Through disciplined leadership, Everest delivered measurable ROI, enhanced quality performance, and a sustainable operational framework for continued growth across all facilities.
Key Takeaway
This success story demonstrates how strategic, data-driven management can restore both financial stability and quality outcomes across complex multi-facility skilled nursing operations. Everest’s proven approach, combining rate recovery, staffing stabilization, and operational efficiency, consistently transforms underperforming portfolios into high-performing, sustainable assets.
Is your skilled nursing network facing census decline or financial instability? Partner with Everest Management Solutions to achieve operational excellence, rebuild workforce stability, and drive measurable quality and financial improvement.
Client names and identifying details have been omitted to maintain confidentiality.