The LTC Provider’s Playbook: Q4 2023 Edition

2023 has been another defining year for long-term care and major changes are expected in the coming years. Operators and administrators need to stay ahead of the curve as COVID-era waivers and regulations are being unwound and new rules come into action. In this quarter’s edition of the LTC Provider’s Playbook, we cover CMS’ staffing standard and review state programs working to help the skilled nursing workforce recover. We also review changes coming to the value-based purchasing (VBP) program for skilled nursing facilities (SNFs) and hear from LTC Ally’s experts on the downsides of Medicare Advantage (MA) plans in long-term care.

CMS Staffing Mandate and State Programs for Workforce Growth

On September 1st, CMS announced its Minimum Staffing Standard for Long-Term Care (LTC) facilities, just a day after a study was accidentally published that reinforced many experts’ opinions that a mandate alone would not improve care quality within SNFs. Regardless, the proposal has been issued for Medicare and Medicaid-certified facilities, giving non-rural facilities 3 years to meet standards and rural facilities 5 years. 

With little apparent incentive to support workforce growth through increased Medicare funding, there is good news elsewhere. 

The HHS is awarding $100 million in grants to help increase the number of nurses across the nation. A significant portion of that will go to supporting faculty at nursing colleges, many of whom have left in recent years due to unsatisfactory compensation. 
A recent video by LTC Ally’s Steve Shain, EVP of Contracting, explored how the faculty bottleneck impacts the entire healthcare industry.

State ‘Learn and Earn’ Programs Helping the LTC Workforce Recover

From Florida to Hawaii, states and organizations are taking the initiative to build up the healthcare workforce before the inevitable demand for skilled nursing and post-acute care outgrows supply. For operators, there is hope and help available to turn traditionally high-turnaround positions into career paths that give essential workers more incentives to stay at facilities and grow their careers in skilled nursing.

In Wisconsin, Medicaid money has enabled the state to create a program that hires and trains CNAs for free and gives them a retention bonus after completing their training. The WisCaregiver Careers program accounted for $8 million out of $100 million set aside in the state’s budget to improve its healthcare workforce and is showing promising results. 

Hawaii’s largest post-acute care operator, Ohana Pacific Health, has created a career pipeline for CNAs to become LPNs, supported by state initiatives that guarantee employment and funding for the training. The program demonstrates the important role large operators can play in helping skilled nursing facilities train and attract more workers.

Indiana has kicked its Next Level Jobs initiative up several gears with additional funding going to employers who train and retain CNAs for at least six months. With $5,000 reimbursements for training, CNAs also receive a pay raise upon completion. Indiana Health Care Association’s Nick Goodwin says “The retention numbers are up for that position.”

Changes to the SNF VBP Program in a Post-COVID Era

As the PHE ends, with it comes the unwinding of many COVID-era changes. Among those is the suppression of the 30-day all-cause readmission measure that was in place under the PHE. Starting October 1, that measure will be unsuppressed. 

Additional measures will be monitored for the SNF VBP Program, including:

  • Long-stay resident falls that cause major injuries (2027)
  • Percentage of residents who meet or exceed expected discharge score (2027)
  • Hospitalizations per 1,000 long-stay resident days (2027)

CMS will continue its SNF 5-Claim Probe and Educate Review that began in June after projecting an improper payment rate of over 15% in 2022. Operators who haven’t already received record review requests should expect to receive them. Read AHCA’s report to learn more.

LTC Ally’s Experts Weigh in: MA Plans and Downside for SNFs

In last quarter’s Playbook, we looked at data from CMS on Medicare Advantage (MA) utilization among SNF residents. Use of MA plans is growing and is widely expected to continue to grow. There are downsides, however, that operators should know about. 

According to LTC Ally’s experts, the following key areas are where MA plans fall short for SNFs:

  • MA plans generally pay lower rates and cover shorter lengths of stay
  • MA plans pay slower, meaning higher days sales outstanding (DSO)
  • MA plans incorrectly deny claims more frequently than Medicare
  • More authorizations are required with MA plans

In general, MA plan providers have a much greater incentive to provide preventative care than traditional fee-for-service plans. When it comes to post-acute and long-term care, they are less likely to authorize care that clinical experts in LTC would traditionally deem necessary. 

Getting ahead of authorizations is a necessary strategy to prevent delays in care. Make sure MDS nurses are creating complete clinical pictures of residents so authorizations can be approved more easily. RCM departments should also expect a longer tail on MA plan reimbursement and factor this in. 

As MA plans become more popular, a gradually larger share of the census will include residents covered with these plans. By understanding the common bottlenecks with MA plans, operators and administrators can educate their staff on what to expect and build these expectations into their projections.

Stay Ahead with Proven Partners in Long-Term Care

At LTC Ally, we provide skilled nursing and long-term care operators with a complete suite of solutions that improve facility operations and help achieve growth goals. We are proven partners helping operators thrive in today’s industry.

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Founded in 2006, LTC Ally serves the long-term care industry with an unbound dedication to improving back office and financial operations. With a mission to reduce burdens and increase peace of mind, LTC Ally set out to revolutionize the way facilities handle their revenue cycle management. With a full suite of financial, case management, and contracting solutions for healthcare providers, LTC Ally is your partner in long-term care and skilled nursing.

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