{"id":4099,"date":"2023-10-31T16:35:15","date_gmt":"2023-10-31T16:35:15","guid":{"rendered":"https:\/\/ltcally.com\/articles\/?p=4099"},"modified":"2023-11-06T21:15:07","modified_gmt":"2023-11-06T21:15:07","slug":"ltc-providers-playbook-q4-2023","status":"publish","type":"post","link":"https:\/\/ltcally.com\/articles\/ltc-providers-playbook-q4-2023\/","title":{"rendered":"The LTC Provider\u2019s Playbook: Q4 2023 Edition"},"content":{"rendered":"\n<p>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\u2019s edition of the LTC Provider\u2019s Playbook, we cover CMS\u2019 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\u2019s experts on the downsides of Medicare Advantage (MA) plans in long-term care.<\/p><div id=\"ez-toc-container\" class=\"ez-toc-v2_0_82_2 counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Table of Contents<\/p>\n<span class=\"ez-toc-title-toggle\"><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/ltcally.com\/articles\/ltc-providers-playbook-q4-2023\/#CMS_Staffing_Mandate_and_State_Programs_for_Workforce_Growth\" >CMS Staffing Mandate and State Programs for Workforce Growth<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/ltcally.com\/articles\/ltc-providers-playbook-q4-2023\/#Changes_to_the_SNF_VBP_Program_in_a_Post-COVID_Era\" >Changes to the SNF VBP Program in a Post-COVID Era<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/ltcally.com\/articles\/ltc-providers-playbook-q4-2023\/#LTC_Allys_Experts_Weigh_in_MA_Plans_and_Downside_for_SNFs\" >LTC Ally\u2019s Experts Weigh in: MA Plans and Downside for SNFs<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/ltcally.com\/articles\/ltc-providers-playbook-q4-2023\/#Stay_Ahead_with_Proven_Partners_in_Long-Term_Care\" >Stay Ahead with Proven Partners in Long-Term Care<\/a><\/li><\/ul><\/nav><\/div>\n\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"CMS_Staffing_Mandate_and_State_Programs_for_Workforce_Growth\"><\/span>CMS Staffing Mandate and State Programs for Workforce Growth<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>On September 1st, CMS announced its <a href=\"https:\/\/www.cms.gov\/newsroom\/fact-sheets\/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid\">Minimum Staffing Standard for Long-Term Care<\/a> (LTC) facilities, just a day after a study was <a href=\"https:\/\/skillednursingnews.com\/2023\/08\/leaked-cms-study-undercuts-a-potential-nursing-home-minimum-staffing-mandate\/\">accidentally published<\/a> that reinforced many experts\u2019 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.&nbsp;<\/p>\n\n\n\n<p>With little apparent incentive to support workforce growth through increased Medicare funding, there is good news elsewhere.&nbsp;<\/p>\n\n\n\n<p>The HHS is awarding $100 million in grants to help<a href=\"https:\/\/www.hhs.gov\/about\/news\/2023\/08\/10\/biden-harris-administration-announces-100-million-grow-nursing-workforce.html\"> increase the number of nurses<\/a> 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.&nbsp;<br>A recent video by LTC Ally\u2019s <a href=\"https:\/\/www.linkedin.com\/in\/steveshain\/\">Steve Shain<\/a>, EVP of Contracting, explored how the faculty bottleneck impacts the entire healthcare industry.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"What&#039;s really behind the staffing shortage in healthcare? | LTC Ally\" width=\"1778\" height=\"1000\" src=\"https:\/\/www.youtube.com\/embed\/Hh7Ia1J8jco?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h3 class=\"wp-block-heading\">State \u2018Learn and Earn\u2019 Programs Helping the LTC Workforce Recover<\/h3>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>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 <a href=\"https:\/\/wiscaregivercna.com\/\">WisCaregiver Careers program<\/a> accounted for $8 million out of $100 million set aside in the state\u2019s budget to improve its healthcare workforce and is showing promising results.&nbsp;<\/p>\n\n\n\n<p>Hawaii\u2019s largest post-acute care operator, Ohana Pacific Health, has created a <a href=\"https:\/\/www.ohanapacific.com\/cna-to-lpn-bridge\">career pipeline for CNAs to become LPNs<\/a>, 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.<\/p>\n\n\n\n<p>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\u2019s Nick Goodwin says \u201cThe retention numbers are up for that position.\u201d<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Changes_to_the_SNF_VBP_Program_in_a_Post-COVID_Era\"><\/span>Changes to the SNF VBP Program in a Post-COVID Era<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>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.&nbsp;<\/p>\n\n\n\n<p><a href=\"https:\/\/skillednursingnews.com\/2023\/06\/why-nursing-homes-should-expect-far-reaching-effects-from-cms-expanded-vbp-measures\/\">Additional measures<\/a> will be monitored for the SNF VBP Program, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Long-stay resident falls that cause major injuries (2027)<\/li>\n\n\n\n<li>Percentage of residents who meet or exceed expected discharge score (2027)<\/li>\n\n\n\n<li>Hospitalizations per 1,000 long-stay resident days (2027)<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p>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\u2019t already received record review requests should expect to receive them. Read <a href=\"https:\/\/www.ahcancal.org\/News-and-Communications\/Blog\/Pages\/CMS-Initiates-National-SNF-5-Claim-Probe-and-Educate-Review.aspx\">AHCA\u2019s report<\/a> to learn more.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"LTC_Allys_Experts_Weigh_in_MA_Plans_and_Downside_for_SNFs\"><\/span>LTC Ally\u2019s Experts Weigh in: MA Plans and Downside for SNFs<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>In <a href=\"https:\/\/ltcally.com\/articles\/ltc-providers-playbook-q3-2023\/\">last quarter\u2019s Playbook<\/a>, 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.&nbsp;<\/p>\n\n\n\n<p>According to LTC Ally\u2019s experts, the following key areas are where MA plans fall short for SNFs:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>MA plans generally pay lower rates and cover shorter lengths of stay<\/li>\n\n\n\n<li>MA plans pay slower, meaning higher days sales outstanding (DSO)<\/li>\n\n\n\n<li>MA plans incorrectly deny claims more frequently than Medicare<\/li>\n\n\n\n<li>More authorizations are required with MA plans<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p>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.&nbsp;<\/p>\n\n\n\n<p>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.&nbsp;<\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Stay_Ahead_with_Proven_Partners_in_Long-Term_Care\"><\/span>Stay Ahead with Proven Partners in Long-Term Care<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>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\u2019s industry.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><a href=\"https:\/\/ltcally.com\/services\/\">Explore Our Services<\/a><\/h3>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h3 class=\"wp-block-heading\"><a href=\"https:\/\/www.linkedin.com\/company\/ltc-ally\/\">Follow Us on LinkedIn<\/a><\/h3>\n","protected":false},"excerpt":{"rendered":"<p>Read The LTC Provider\u2019s Playbook for essential insights into the CMS staffing standard, downsides to MA in long-term care, and upcoming changes to VBP.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"content-type":"","footnotes":""},"categories":[21],"tags":[],"class_list":["post-4099","post","type-post","status-publish","format-standard","hentry","category-newsletters"],"yoast_head":"<!-- This site is optimized with the Yoast SEO 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