If you’re 65 years old, about to be 65 years old, or if you know somebody who is, here’s a message for you: Don’t wait to sign up for, or change, Medicare insurance plans - poor planning, procrastination and missed deadlines expedite the aging process!

The Medicare Open Enrollment Period is October 15^th through December 7^th, and it’s time to make decisions about your future now - changes made during this period will take effect January 1^st of next year.

Here’s a brief overview of some upcoming deadlines:

• Part A, B, D – Enrollment begins 3 months before and up to three months after you turn 65.
• Medicare Supplement Insurance (Medigap) – Medigap open enrollment lasts 6 months and begins when 1) You are 65 or older 2) Have enrolled in Medicare.
• Working past age 65 – You must enroll within 8 months of being unemployed or dropping your health plan.

What each part means:

Part A – Hospital insurance: Covers inpatient care, hospice, home health and skilled nursing care.

Part B – Medical insurance: Covers outpatient care, preventative services and medical equipment such as wheelchairs and walkers.

Part D – Prescription drug coverage

Medicare Supplement Insurance (Medigap) – Covers some of Medicare’s cost-sharing requirements and services not covered by Medicare.

Why you should take advantage of this enrollment period:

• Possibility of upgrading or downgrading plans (Medicare Advantage versus Original)
• Opportunity to reevaluate or change Part D
• Peace of mind knowing that you do not have to rely on COBRA or job security in order to be covered by insurance.

Good to know:

• The general enrollment period for Medicare is between January 1^st and March 31^st
• During the general enrollment period, coverage kicks in one month post-enrollment.
• You can apply for Medicare even if you are already covered elsewhere.
  
  

Excuse us as we take a victory lap celebrating another successful conference! The 2023 AHCA/NCAL Convention & Expo was certainly one to remember, and we are excited about the new (and old) connections we have cultivated along the way. 

Amongst other opportunities, we had the chance to discuss with RevSpring's vice president of business development, Eric Langlee, in person about our new partnership with them, specifically regarding private pay integration with primeCLAIMS. The partnership, officially announced last week, empowers revenue cycle managers in the post-acute care industry to efficiently manage payments from guarantors for better financial outcomes. We'd be happy to discuss what this means for you via email!

Here are our Top 3 Takeaways from this year's 'Delivering Solutions' :

1. Congrats to all the newly elected board directors of AHCA/NCAL! Some notables: Phil Scalo of New Jersey was elected as AHCA Chair, Mark Maxfield of Idaho was elected as NCAL chair, and Chris Wright of iCare Health Network, a current client of ours, was elected Vice Chair.
2. There was a lot of buzz surrounding the new CMS staffing mandate and its anticipated impact. See our September 9th and October 1st blog posts for more details.
3. Managed Care insurance companies continue to squeeze providers on reimbursement, meaning that to manage the contracting process successfully, there needs to be more focused efforts on the providers side as far as effectively communicating their value to payors to drive down costs and improve healthcare quality.

Prime Care Technologies was also proud to sponsor this year's opening event, the Mile High Jamboree, to kick off the conference. We had a great time socializing, racing, and discussing all things post-acute care! Overall, AHCA was a blast, although we weren't quite ready for the white waters of Denver!

In case you didn’t know, October 8^th-14^th is National Case Managers Week, so now is an opportune time to celebrate the important work performed by case managers everywhere, but specifically those within the healthcare industry.

So what are case managers, and what do they do?

Case managers play a vital role in maintaining the operational efficiency within the companies they work for, from admission to discharge. They are the keystone in all workspace systems, processing and creating productive workflows, organizing and delegating responsibilities, maintaining order, handling sensitive data, and ensuring that all tasks are being completed in a timely fashion. It’s a job that requires immense attention to detail, excellent communication skills, flexibility, forward-thinking, and a little finesse. It certainly is not an easy position to hold, and challenges are abounding, especially if relying on a manual case management method.

Common challenges that case managers face are:

• Ineffective collaboration between individuals and teams due to lack of flexibility and coordination.
• Lack of transparency for customers and stakeholders due to the complex, multi-faceted nature of the position.
• Decreased efficiency due to mismanaged assignments, poor team communication, inefficient data collection, and weak process structure.
• Increased documentation mistakes due to human error render data unusable, making analyzing trends more difficult and timelier.
• Information salad due to sources being scattered across multiple platforms and channels, making the information-gathering process cumbersome and frustrating.
• Lack of customization makes it difficult for case managers to adapt operations to streamline the company's processes and workflows, dramatically increasing operational costs.

Luckily, digital and technological advancements have helped to lighten the load ̶ case managers rejoice! Platforms like our managedCareMASTER make managing complex contracts, EHRs, Rx costs, therapy, and CRM easier than ever. managedcareMASTER is your automated case management and contract workflow platform, covering everything from contract summaries, organizational visibility, and contractual alerts to concurrent reviews, denials, and appeals. Case managers no longer have to rely on papers and binders to keep track of everything they need ̶ it’s available to them in one, all-inclusive dashboard. The executive dashboard includes useful functions such as a concurrent review and authorization calendar, facility-based cost-out template, PDPM grouper tool, high-cost medication search, and real-time alerts, allowing case managers to take charge of their facilities with resounding efficiency. Say goodbye to poor collaboration, incomplete data, visibility issues, compromised security, and avoidable errors!

Have any questions about how our technology can help you? We’d love to hear from you!

Drop us a quick email, and we’ll happily discuss our solutions further with you.

Increased patient acuity numbers in hospitals do not usually signal something positive in the healthcare system ̶ unless you’re a post-acute care facility, that is. But wait, is that even true? It's true that both adult inpatient and tertiary inpatient days are expected to increase by 8% and 17% in the next decade… It's true that hospital inpatient capacity has remained relatively unchanged… It's true that there is a projected 13% growth in home hospice care...

So what’s the negative amidst all those "positive" statistics?

Hospitals and post-acute care facilities will only be able to reap the benefits if they don't get impaled by the small chink in the armor: The new CMS mandates.

Let’s digress for a moment so that we can better understand why that is:

In reviewing a report by Vizient and its subsidiary Sg2, from 2019 through 2022, hospitals saw a 10% increase in patient acuity rate alone on account of more Americans requiring inpatient chronic condition care. However, their capacity has remained relatively unchanged, which means current care delivery models will need to be revised in order to meet the growing volume. Why is that good for post-acute care facilities you may ask? Because in the coming years, hospitals are going to be at their wits end, and post-acute care facilities can be the knights in shining armor, as they have the resources capable of offsetting the additional strains hospitals will face.

So how do the new CMS mandates interfere with that again?

As we debriefed in our September 9^th blog, the new CMS mandates include a minimum staffing rule that increases RN hours from 8 hours/7 days a week, to 24 hours/7 days a week. They’ve been courteous enough to do the math on how much money is needed to implement the new requirements ($40.6 billion!) over the next 10 years, but seem to have run out of brain power when it comes to providing solutions on how to procure those numbers. With no answer on where the funds are coming from to support the additional RN and nursing aide hours being demanded of them, facilities everywhere are being sent into a scramble over how to stay in compliance.

In an ideal world, the CMS would provide some kind of funding solution and all would be well, but they haven’t. Because of this, if one does not move tactfully, the CMS mandates are a double-edged sword that could topple the delicate tower made up of hospitals and post-acute care facilities, with hospitals being at the top. The combination of ever-growing patient acuity cases, increased demand for post-acute care facilities and the lack of funding now has the capacity to overwhelm both hospitals and post-acute care facilities simultaneously. A 2-for-one special, very appetizing.

There’s a strong argument that the CMS mandates will only serve to increase the exclusivity of care, as many facilities will fall out of compliance, challenging the CMS’s opinion that the new proposal will better serve residents by ensuring that they are able to receive the safest and highest quality of care. It seems, rather, that the changes would ultimately limit the overall access to care. Would you rather Grandma have some care or none at all? It is not difficult to see how such ambitious, black and white thinking could severely jeopardize millions of Americans desperately in need of post-acute care.  

Let’s do a quick SWOT analysis of the situation to summarize:

 Strengths

• Post-acute care facilities have the necessary acuity settings to treat patients in need of specialized medical care.

Weaknesses

• The current hospital care delivery models will not support the growing patient volume.
• Hospital inpatient capacity is remaining relatively unchanged.
• Post-acute care facilities need more RN and nursing aides.
• Post-acute care facilities need funding to fulfill the new CMS mandates.

Opportunities

• Hospitals will look to post-acute care facilities to accommodate the increased demand for inpatient medical care.
• Post-acute care facilities can anticipate more revenue opportunities with increased demand.

Threats

• If CMS does not provide funding solutions, many post-acute care facilities will be out of compliance, thus disrupting the hospital-post acute care facility pipeline.

Whether the new CMS mandates are going to help or hinder the ability for post-acute care facilities to keep hospitals from drowning in the moat, time will only tell.

As many are aware, Caesars Entertainment and MGM Resorts International experienced cybersecurity breaches last week that resulted in the shutdown of casino and hotel computer systems from Las Vegas to New York. The breaches were executed by ransomware groups, who gained access through tactics like text messages and phishing emails. In the case of MGM, hackers posed as an employee and contacted the help desk to request a password reset. Caesars Entertainment quietly paid a $15 million ransom to the hackers. The breaches proved to be a logistical and financial nightmare, affecting reservations, casino floors, room accommodations, and other issues that cost both the guests and venues tremendously.

The cyberbreaches serve as a painful reminder to all that the need for cybersecurity is at an all-time high. Casino security is often regarded as near-impossible to penetrate, however, that doesn’t deter nor prevent attacks, as we already know by now; Where there is money to be had, there will be thieves and unfortunately, MGM and Caesars are all too familiar. Entertainment venues are certainly not stand-alone victims, with other major industries targeted including healthcare, education, and government agencies. 

As healthcare continues to go digital through artificial intelligence and other avenues such as telehealth and telemedicine, the need to software that can ensure safe, secure data storage and protection is imperative. Although the healthcare sector has not seen the worst of data breaches, it has seen some of the most expensive; Multiple incidents have occurred within the past year of leaked personal information about patients and residents that have cost facilities hundreds of thousands. The topic of cybersecurity is no longer about if you need it, but how to implement it for maximum effectiveness.

Here are some ways to protect yourself:

• Training: Strengthen your weakest link by making internal spam/phishing training obligatory for all employees. Most cybersecurity breaches occur due to human error. Make sure everyone is well-versed in recognizing potential sources of malware and malicious modes of communication.
• VPN: Strengthen your home network via VPN encryption to ensure no sensitive data can be intercepted by cybercriminals. Limit identity theft opportunities for cybercriminals by guarding your personal information and practicing discernment when probed for personal details.
• Passwords: Use strong, unique passwords and change them often. Use multifactor authentication. Make sure that your one-time passwords are up to date. Doing all the above limits the ability for hackers to key track and recognize password trends.
• System Updates: Keep your software and operating system up to date and invest in the best cybersecurity system you can afford. Remember, nobody is safe and an educated investment, thought pricey, may save you far more in the long run.