Maple Knoll Village

Skilled Care Pharmacy Establishes New Partnership with Maple Knoll Communities

Skilled Care Pharmacy, the Midwest’s leading institutional pharmacy that provides caring and expert medication dispensing to healthcare facilities, and Maple Knoll Communities, one of Cincinnati’s largest senior living organizations, have established a new partnership in which Skilled Care will be the main pharmacy provider for all of Maple Knoll Communities.

Through this partnership, Skilled Care Pharmacy will become the pharmacy partner for Maple Knoll Communities,
which includes the exceptional retirement communities of Maple Knoll Village and the Knolls of Oxford, Sycamore Senior Center, three affordable HUD Senior Living Residences, Maple Knoll Home Health Services, WMKV 89.3 & 89.9 FM Radio Station, a Montessori Child Center, and the Hemsworth Wellness Center. Larry Galluzzo, CEO of Skilled Care Pharmacy, noted Maple Knoll is the perfect fit for Skilled Care Pharmacy’s expertise.

“The number one priority of both our organizations is ensuring the health and wellbeing of older adults so they can live happy, healthy and active lives,” Galluzzo explained. “We know we’ll be able to bring value to their organization, just as we know we’ll learn a great deal from their approach to care.”

One of the most valuable assets Skilled Care Pharmacy brings to the partnership is its ability to deliver significant cost savings without compromising resident quality of life or care. For every medication the company recommends adding, it recommends discontinuing eight. Those reductions—coupled with the company’s approach to substituting medications and competitively pricing its products—can save senior living communities up to $1,000 per resident annually.

With multiple sites and hundreds of seniors in its care, the opportunity to operate more efficiently and reduce patient dependency on medication was an attractive business proposition to Maple Knoll Communities. The organization will also take advantage of Skilled Care Pharmacy’s extensive training and ongoing education programs.

“We are excited to start this new venture with Skilled Care Pharmacy. The experience and expertise they bring to the table can only further our commitment to providing the best care possible to those we serve,” said Jim Formal, president and CEO of Maple Knoll Communities.

The partnership is effective as of October 28, 2014.

Skilled Care Pharmacy provides expert medication dispensing and a variety of consultative services to health care organizations across the Midwest in a partnership defined by timeliness, accessibility, and continuous improvement. Skilled Care was founded in 1981 and currently serves more than 10,000 residents every day in 100-plus facilities. Skilled Care pharmacists are among the industry’s best and are available 24-7 to address client needs and provide actionable advice – including how to reduce the medications residents take, making them healthier and saving money. For more information, visit or follow us on Twitter or LinkedIn.

Maple Knoll Communities, Inc. is a nationally recognized leader in the care and support of older adults. Since 1848, Maple Knoll Communities, Inc. has offered innovative, holistic residential and community-based programs that improve the quality of life and respond to individuals’ changing needs as they age. Find more information at


Electronic Medical Records and Your Healthcare

In 2009, Congress enacted the American Recovery and Reinvestment Act of which Title XIII is the HITECH Act or Health Information Technology for Economic and Clinical Health Act. That is a mouthful. The goal is to create a nationwide network of electronic health records to enhance healthcare and reduce costs through better communication. Financial penalties will go into effect in 2015 for institutions and physician’s offices not in compliance that receive money from Medicare and Medicaid.

Behind the scenes a whole lot of data entry has been going on in healthcare to make this happen. The upside for the healthcare consumer, is that critical health information can be available 24/7 and much quicker than before. The downside is that years will be spent tweaking, updating, and evaluating these programs to ensure they are meeting the goals set. As a consumer of healthcare, there are things to know about this process and things you can contribute to make sure the electronic medical record works for you.

Each healthcare system has their own electronic record and they do not communicate with each other automatically. If you see a primary care physician with UC Health and go to a cardiologist with TriHealth and see an independent dermatologist, and then are admitted to a hospital in an emergency outside of either of those systems, the data in your medical record is in four different systems. Each system may think it has the correct picture of you and your needs.

The Electronic Medical Record is only as good as the data entry and the person entering the data. Errors can be made with the click of a button. Personal Example: After a visit to an emergency room, I found out that a local medical system has me listed as taking three prescription medications on an ongoing basis. I take none. A dermatologist office I visited ten months ago made a data entry error and did not specify in the record that these medications were to be taken for only 2 weeks. I was unable to get the emergency room to correct the record and the discharge papers told me to continue taking three medications that I do not take. No harm done, I know better. Had I been admitted, a physician would recognize these as 2 week kind of medications and would not have ordered them. A problem could have come up if a new medication was ordered that showed negative interaction with one of the “not taken” meds. A flag in the system would suggest a different medication be taken which might not be as therapeutic. It could then be ordered with a click of the button and no looking into the issue.

Here is an example of the most frequent problems we find with the system. A patient is admitted through the emergency room. The medication record is pulled up and medications are ordered based on what was correct six months ago. There have been changes in the medication by a physician outside of that hospital’s system one month ago. The changed medication may not be related to the current admitting diagnosis. This leads to a medication error called an unintentional med change. It has become quite common since the advent of electronic records.

It is our responsibility as our own health advocates to help the system and ensure our own health and wellbeing. Know your medications, what they are prescribed for, the doses and who prescribed them. Carry an updated list with you all the time, especially if you take multiple medications. Where ever you are seen in the health care continuum, hand over a copy of this list. If you are admitted to the hospital, ask to see the MAR or Medication Administration Record. This is the paper the nurse uses to administer medications as ordered and document them as given. Make sure this matches your list and find out about any changes. Don’t assume that because you have handed over a correct list, that is what will be ordered. Request that your medical record be updated whenever you see errors and request a paper copy of the update.

Update on Maple Knoll Regarding the Ohio State Budget
July 29, 2011, 3:44 pm
Filed under: caregivers, medicaid, Resources | Tags: ,

In an April post, I mentioned the proposed budget cuts for the state of Ohio and how it could produce losses for Maple Knoll Village amounting to $4 million over a two-year period.  Now it’s July and we have a new state budget that comes with good news and bad news.

The good news is the loss to our organization is not as harsh as originally expected.  The bad news is its still a significant loss for Maple Knoll.  Currently we receive $9.4 million in Medicaid reimbursement from the state.  Under the Governor’s proposal, we stand to lose $2.15 million, a 22% reduction.  The final budget results in Maple Knoll Communities losing $1.6 million in year 1 and the full $2.15 in year 2.
Although the results are disheartening, what I find inspiring is the way our staff and residents came together to have their voices heard in Columbus.  Approximately 11,500 letters and emails were sent to state legislatures! 
In addition, members of the executive staff met with local Senators and State Representatives and testified before the Senate Finance Committee, asking for fair treatment.  We will continue these efforts.
Now is the time to focus on what we can do to keep our organization strong while continuing to provide quality care.   We’ve already begun doing this by looking at areas where we can reduce expenses and increase revenue.  For example:

•  Discontinued outsourcing therapy and hired in-house therapists

•  Discontinued the SeniorFitness program and hired in-house instructors for the Wellness Center

•  Outsourced some MKC billing functions

•  Implemented 12-hour shifts for STNA’s, LPN’s and RN’s in Bodmann Pavilion

•  Made staffing changes through attrition and repositioning

•  Awarded new groundskeeping service to the lowest bidder

•  Converted available space into two additional apartments in Breese Manor Assisted Living

•  Contracted with OneSource Employee Management, LLC, a Professional Employer Organization (PEO) in order to combat Ohio’s expensive workers compensation system

 We’re doing everything we can without cutting in to the high standards that we are all very proud of.
Coming off the heels of an A+ state survey for Bodman Pavilion, it’s even more difficult to ask our employees to make sacrifices.  The success of Maple Knoll lies with the people that show up everyday, punch the clock and go to work.  Putting smiles on faces, bringing out the best in our community and making our residents top priority.
I realize kind words are not a form of currency, if they were, Maple Knoll employees would be rich. 

Thank you,

Jim Formal

President and CEO, Maple Knoll Communities


Answers about the new proposed Ohio Medicaid cuts from the Governor
April 5, 2011, 2:56 pm
Filed under: medicaid | Tags:

Governor Kasich recently released the proposed state budget for the next two years.  Severe cuts are outlined in an effort to close the gap on an $8 billion deficit and everyone, from local government, to educators to healthcare providers, will be required to do more with less.

Over the last several weeks, I’ve encountered questions from residents, employees, and the very politicians that will be voting on these changes. Below is a Q&A.

What part of the Governor’s cuts will affect Maple Knoll Village?

In the proposed budget, the Governor plans to cut Medicaid funding for nursing homes by $427 million over the next two years.                                                                               

Is the Governor targeting nursing homes?

No.  The proposed Medicaid cuts will reduce spending by $4.3 billion over the biennium, affecting nursing homes, hospitals, pediatric hospitals and community based nursing services.

What is the difference between Medicare and Medicaid?

The biggest difference is that Medicare is a federal governed program and Medicaid is run by the state.  Specifically to Maple Knoll, Medicaid is for patients requiring nursing home care that can no longer afford it. 

Shouldn’t we all tighten our belts?

Absolutely and we want to play a role in balancing the state budget.  What disconcerting is the method that the state plans to use to determine the distribution of Medicaid. The loss of $427 million averages out to a loss of approximately $500,000 per facility, but under the reimbursement formula, some will gain over $500,000 while others lose over $1,000,000.

How is it possible that some nursing homes will actually make money?

Without getting too complicated, the state assigns each facility a cost rate that is used for reimbursement.  A “per bed” or “per patient day” cost that is based on the actual cost spent on a facility.  For some it may be $130 per day and for others it may be $200.  Usually the for-profit, independently owned, have a lower price cost and they stand to actually make money from this proposal.

Are there for profit and non-profit nursing homes in Ohio? 

Yes.  Non-profit, like Maple Knoll Village, take profits earned, and reinvest them in staff and facilities.  We are mission driven to provide quality care and a quality life, not make money.  For-profits are run like a private business, they can reinvest in their business or they can keep their profits.  So those that spend money on their facilities and programs will have a higher cost rate and will lose more money than those that spend less on their business.

Is the state trying to push non-profit nursing homes out of business?

It’s a case of not understanding how the industry works. State regulations have us working under a double-edged sword where we are required to do more with less or a fine is imposed.  The state tells us we can get by with one aide per 15 patients but we know that’s impossible and would only compromise the care of our residents. Our goal is to always do more, not to avoid a fine, but because it’s the right thing to do.

How is this going to impact Maple Knoll Communities?

Our organization stands to lose $4 million over the next 2 years.  Although it is estimated that 7,000 jobs related to nursing home care will be lost in the state due to proposed cuts, that is the last place where we will look.  Money will always be reinvested in to the care of our residents before anything else.

If these are lean times, why do I see renovations on campus?

Again, Maple Knoll is a non-profit and fund development is a key part of our organization.  There are times when we receive generous financial gifts that are earmarked for a specific project and we are obligated to honor that request.  If you see projects directly related to operations, it’s because we have found a more efficient approach that will save money in the long run.

Didn’t they already cut Medicaid payments a few years ago?

The state submits a new budget every two years and we continue to do our part in balancing that budget.  In 2009 we did see a decrease in payments which resulted in job cuts here at Maple Knoll.  We are currently working with a very lean Management staff where most folks are doing the job of 3 and our organization relies heavily on volunteers. 

What is the likelihood of the proposed budget being passed?

The proposed budget is now in the House of Representatives and the likelihood of this going through is very high.  The new budget takes effect in June, 2011.

What are you doing to prevent the changes?

We are visiting with Legislators in Columbus to share information and to create awareness about the disparities with which facilities are affected.

What can I do to help?

You can voice your concerns through letters, emails and phone calls to your Senators and State Representatives. 

I’m available to address and questions or concerns that you may have.


Jim Formal