Virginia Health Services’ Post

Minimum staffing levels for long-term care and skilled nursing facilities (SNFs). At first glance this appears to be a good idea. More staff at the bedside caring for residents. Improved quality of care. Not to be a downer, but let's look at possible downstream issues... SNFs do not have adequate staff to meet the requirements for the number of beds. Nursing staff is in short-supply across healthcare - not just SNFs. SNFs may 'close' beds or not admit patients until current residents are able to be discharged to avoid violating the regulation. Hospitals have patients who need skilled care upon discharge. Patients will remain in inpatient hospital beds until a skilled (SNF) bed is available. Patients will remain in emergency departments waiting for an inpatient bed which is occupied by a patient who is waiting for a SNF bed. There are so many issues up and down the healthcare system that will be exacerbated by minimum staffing requirements in SNFs. Let's dive deeper, get to the root cause of the problem, and address THAT issue.

The Biden Administration recently announced the Nursing Home Minimum Staffing Rule (https://bit.ly/3Uix07O), intended to strengthen and support #NursingHome regulations related to the nursing workforce to improve quality life for individuals living in nursing homes.    There are many strong opinions on both sides of this ruling. While it’s an important step supported by many nursing home residents, stakeholders, and policymakers across the United States, some organizations have expressed concern that the final rule will result in staffing challenges, particularly in rural areas, or that the rule does not go far enough in terms of staffing minimums based on previous studies. Notably, this is the first time the White House has put out a final rule to measurably and concretely improve staffing in nursing homes.   Despite the differing opinions on this specific rule, no one disputes that staffing needs to be improved in nursing homes. Nursing homes require adequate nurse and Certified Nursing Assistant (CNA) staffing and leadership to integrate age-friendly care into each resident’s daily life.    I’m encouraged by the increased federal focus on staffing models that will best address what matters to the 1.2 million individuals living in US nursing homes, and the dedicated professionals that work there. We plan to continue working with federal and state agencies on implementation of these new staffing standards.   One of the ways we will continue working on this crucial issue is through the Moving Forward Coalition – a multi-stakeholder initiative to create practical and sustainable change in nursing homes. Moving Forward is supported by nearly four dozen organizations, and it’s chaired by IHI’s Senior Advisor for Aging, Alice Bonner, a career nursing professional and leader with decades of experience working to improve care and quality of life in nursing homes.   I’m confident that our efforts with the Moving Forward Coalition and the Age Friendly Health Systems movement are bringing about real and meaningful change in nursing homes. And I’m optimistic that this new federal rule, effectively implemented, will increase momentum. But we need your help too. If you or your organization is interested in helping improve nursing home care in the US, please reach out to us at Age-Friendly Health Systems (https://bit.ly/3JJGyDO) and at info@MovingForwardCoalition.org.   #AgeFriendlyCare #Geriatrics Centers for Medicare & Medicaid Services

Seniors..#medicareadvantage plans have a reputation of kicking the patient out of a nursing home rehab before the patient is ready to be released by the doctor. #medicareadvantage plans are also limited with their nursing home rehab networks - the pickings are slim. #medicareadvantage #medicare #cms #publicpolicy #publichealth #gotanotherone #nursinghomes #Longtermcare #rehabilitation #senators #elderly #physicians #nurses #seniorcitizens #skillednursing # #stoptheprivatizationofmedicare #medicareadvantageisadisadvantage

Survey study assesses the 2019 spending estimates on checkups, well-child visits, and diagnosis or treatment provided by primary care physicians, nurses, nurse practitioners, and physician's assistants. https://ja.ma/43Yrkm7

This Beckers article was recently republished in Beckers Post -Acute newsletter and I feel compelled to respond. As an administrator who has work in both acute and post-acute healthcare over the past 45 years, there are clinical, regulatory and reimbursement barriers to the smooth transition between acute and post-acute venues. Stigma: Most, if not all patients and their families, have a negative impression of the term 'nursing home', and, unfortunately, some providers and the media have exacerbated that view. Most hospitals have transitioned to private room accommodations for the majority of their inpatients where nursing facilities, due to financial and/or space constraints, have been stuck on semi-private rooms for their "skilled" patients. Hospital discharge planners have a hierarchy of facilities to reach out to for beds and that list may be further truncated by the patient or their family. Census is critical for long term care facilities. Placing a skilled patient in a semi-private room with a long term care resident is, in most circumstances, less than ideal and can add to the stigma concern. Regulation: Nursing facility bed certification has become a regulatory and reimbursement dance for the past 30 years. If you dually certify a bed for Medicaid (long term) and Medicare (short stay/skilled care), you eliminate a valid reason to move a resident after their "skilled" stay has terminated and they cannot return home; either through total use of the 100 day limit for Medicare skilled coverage or the fact that the resident no longer qualifies for skilled care based upon their progress in rehab and qualifies for Medicaid. If you certify a bed as Medicare Only, that bed cannot be occupied by a Medicaid, long term care resident. It could be occupied by a private pay resident, however. Reimbursement: Clearly, a Medicare qualified, skilled care patient has much more potential for creating a positive operating margin for the facility. However, many of these referrals from acute care facilities have co-morbidities or conditions that may impact ongoing skilled recertification and/or require expensive medications and ongoing treatments that must be identified prior to admission and used to increase their RUGS classification or be "carved out" and reimbursed separately from the agreed upon daily reimbursement rate. This can be a major stumbling block for acute care hospitals and I have experienced hospitals paying for medications to assist in discharging those patients. Cooperative Relationships: Throughout my career, I have never understood the dichotomy between acute and post-acute care. Many acute care hospitals refer to themselves as "Health Systems" but have no access to post-acute venues. Maybe reserving a block of LTC beds at a nursing facility would provide a viable answer for this in the short term. Providing cash flow for the nursing facility and holding short term accommodations for the hospital to access. Hmmm!

Skilled Nursing Facilities (#SNFs) are critical to our health system. While we have historically struggled to integrate them effectively within the system, there is significant potential for improvement. Four years ago, when I began to look at the market segment, only 18% of these facilities passed what I considered to be a meager hurdle in working capital — and that was pre-COVID. Most SNFs are in financial distress and unable to focus on the critical issues associated with the discharge and post-discharge process. Although many individuals may look to avoid the SNF at any cost, the reality is that they play an essential role. Addressing the needs of transitional patients remains a significant upstream and downstream challenge. How are care transitions effectuated? How are families prepared for the return of the resident to their home? What needs to be done? Who efficiently manages the post-discharge period — not just for the 30-day at-risk period, but holistically looking at setting the discharged resident and their family and informal care team up for long-term success? There are currently processes to address these questions, but they rarely work. What are the emotional, social, and financial costs of not adequately addressing these issues? I am reposting an article I wrote two years ago. If you play a role in the SNF market, work in #CareTransitions, are interested in #LongTerm #CareManagement, or take longitudinal financial risk on older adults, I invite you to read through my thoughts. I'd love to speak with you if you're thinking (or, preferably, acting) progressively about how the system should work (or how you would want it to work for your family). If this isn't relevant to you, I would ask you to share it with others. Collectively, we have an opportunity for tremendous social and financial impact, but it needs to move faster! https://lnkd.in/e-yvwwya

The physician fee schedule proposal includes a new payment mechanism to enhance follow-up care in nursing homes for post-surgical patients, such as those with fractures. The Centers for Medicare & Medicaid Services aims to incentivize specialists to provide on-site visits, addressing the current challenge where nursing home staff manage post-surgical care and arrange transport to surgeons. This burdens staff and patients, as noted by Dr. Rajeev Kumar. The proposal seeks to reconsider reimbursement for global services, potentially allowing physicians to bill for visiting nursing home patients and reassign post-discharge care to on-site providers like nurse practitioners. CMS is exploring ways to improve the accuracy of payment for services and is seeking public comments on barriers to high-value care. The proposal highlights the need for comprehensive post-surgical care for fractures, common among the elderly, and suggests new coding for fracture management. This could improve outcomes and quality of life for nursing home residents by ensuring adequate follow-up care. Our team assists in implementing programs like this by providing expert guidance on regulatory compliance, optimizing reimbursement strategies, and facilitating seamless integration of new payment mechanisms. We ensure effective on-site specialist care coordination, improving patient outcomes and reducing the burden on nursing home staff. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner McKnight's Long-Term Care News

Healthcare is evolving with the rise of hospital-at-home technology and innovative programs like home-based skilled nursing. These initiatives aim to transition patients swiftly into post-acute care, slashing costs, reducing hospital readmissions, and relieving hospital capacity constraints. According to Krista Drobac, founder of Moving Health Home, "[Skilled nursing-at-home] is urgent because we have so many patients in hospital beds that don’t need to be there." While traditional fee-for-service Medicare may not cover these services, a few Medicare Advantage and commercial plans do under negotiated value-based contracts. For instance, Inbound Health, negotiates fixed-rate contracts that are more cost-effective than traditional skilled nursing facilities. Inbound CEO Dave Kerwar explains, "It is essentially a rate that is traditionally somewhere between a traditional home health episode and what a traditional brick-and-mortar [skilled nursing] episode is." Modern Healthcare https://lnkd.in/g52h66MC

Exciting News for Nursing Homes and Healthcare! 🏥 The recent CMS ruling on minimum staffing ratios for nursing homes is a game-changer for the industry. Patients: These new ratios will enhance patients quality of life, ensuring that they receive the care and attention they need around the clock. The commitment to their well-being is more important than anything else. Caregivers: Our dedicated nurses & caregivers can now focus on providing quality care, ensuring that residents receive the attention and support they deserve. Better staffing ratios translate to improved patient care! 👩⚕️ 👨⚕️ Recruiting: This ruling opens up new opportunities for healthcare professionals. More nursing & caregiver staff means more career prospects, creating a positive impact on our workforce. Let's welcome fresh talent and expertise into our teams! https://lnkd.in/eNryMFdw Embrace the change! #Healthcare #Nursing #QualityCare

Unfortunately, the Linn Health & Rehabilitation story is emblematic of a wider crisis facing Rhode Island nursing facilities. Nursing Facilities are facing unprecedented increases in nearly all aspects of providing care - staffing costs, energy prices, inflation on food, medical supplies, etc. At the same time, Medicaid rates have not kept pace. In 2023, RI's nursing homes are being paid by Medicaid based on the actual allowable cost of care from 2011 with an average of approximately 1% increase annually. RI Medicaid has ignored the statutory requirement to rebase the Medicaid rate every three years that was intended to keep rates at a reasonable level. The state's FY 2023 budget included a requirement for a fully funded rebase of the RI nursing facility Medicaid rates, but it will not take effect until October 1, 2024. Like Linn, it is likely that other facilities may not survive until that time. There have been discussions with state leaders regarding more immediate action - possible bridge funding, moving up the 10/1/24 rebase. We have been assured that all options are being explored. Six facilities have already closed since the start of the pandemic. Three others are currently in receivership. While Linn has come out publicly with their operational challenges, there are others. -John E. Gage, MBA, NHA RIHCA President/CEO