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.
  
  

While the current state of the economy can be described as moody, in some industries, there is still potential for growth, namely in the cybersecurity sector.

Everyone knows that when there is an economic squeeze, businesses resort to self-conserving methods to keep their companies alive. Workforces are downsized, contracts are slowed, and executives everywhere search every nook and cranny for money-saving solutions. While the economic downturn has not allowed the cybersecurity industry to go unscathed, the need for it prevails, albeit in a more particular fashion.

As businesses search for savings, the key lies within platforms like Microsoft. Now, with tighter budgets and more stringent purchasing processes, businesses no longer want to spend money on individual products for individual problems ̶ they want a platform that solves all of them concurrently. As the saying goes, they want more bang for their buck. Microsoft is well known for its all-inclusive platform approach, and now that businesses are becoming exceedingly selective, cybersecurity is well on its way, too.

In addition to the economic conditions, cybersecurity has another motive to speed the transition to platform-esque systems. On July 26, the SEC announced that all public cybersecurity vendors will be required to disclose cyberattacks within four business days of the breach if they have a material effect. According to the SEC, the decision was made with the intention of “[hardening] the financial system against data theft, systems failure and cyber-intrusions.” What this means is that many businesses are forced to be more transparent about cyber breaches, giving executives the kick in the pants they need to become more acquainted with their cybersecurity solutions and improve their overall protection. Now that platforms have become the preferred management system for cybersecurity vendors, it is in the best interest of cybersecurity companies to evolve their approach to meet the growing expectations.

The increased vigilance paired with the watchful eyes of penny-pinching CISOs means there is a great opportunity for cybersecurity to expand into a more inclusive, multi-functional, and user-friendly platform that can meet the demands of businesses and individual clients. Improving the level of cyber protection is a mounting necessity across all industries, opening a gateway of opportunity for cybersecurity companies that choose to embrace the new market demands.

There have been mixed reviews about the new mandates released by the Centers for Medicare & Medicaid Services, including a new proposal establishing minimum staffing standards for nursing homes nationwide. The proposal was made with the intention of raising the standard of service at senior care facilities that, according to CMS Administrator Chiquita Brooks-LaSure, will better serve residents by ensuring that they are able to receive the safest and highest level of care at all times (https://www.cms.gov/newsroom/press-releases/hhs-proposes-minimum-staffing-standards-enhance-safety-and-quality-nursing-homes).

But not everyone is happy.

While the intentions of the CMS mandates are in good faith, many senior care facilities are fighting back, referencing multiple issues with the minimum staffing rule. The primary issue is funding. The CMS has stated that in order to fund the new requirements, the total cost over the next 10 years will be $40.6 billion. However, they have not provided any solution for procuring those numbers, sending facilities into a scramble over how to stay compliant without any financial assistance.

The need for such extensive funding is thanks to new requirements that include increasing on-site RN hours from 8 hours a day, seven days a week, to 24 hours per day, seven days a week. RNs must now account for .55 hours per resident day (HPRD), while nursing aides must account for 2.45 HPRD. However, implementing such a demanding mandate requires more cash for the additional RN and nursing aide hours. This is a major flaw in the proposal because facilities do not have the means of increasing wages for current staff or hiring additional staff because there are no funds to pull from.

While there is a waiver process, it is not user-friendly and difficult to navigate, slowing down the efforts to find new workers and, in the meantime, deeming facilities unfit to operate. To keep it brief, the jump from 8 hours to 24 feels excessive to many facilities, making it unreasonably difficult to stay compliant. Critics argue that such an ambitious move will only decrease overall access to care because so many facilities within the sector will be out of compliance.

In preparation for the new CMS requirements, it’s important to look closely at the rule's phase-in parts to ensure a smooth transition. If and when the rules go into effect, it will be in your facility’s best interest to get ahead on your staffing plans for the coming years to maximize recruitment and retention. Staying in compliance will reflect positively on your five-star rating, which will only serve to attract potential residents and staff alike, both of which you will need to remain in good standing. The HPRD requirement for urban buildings will be effective three years after it becomes final, whereas for rural buildings it will be effective after five.

This means it is incredibly important to stay on top of your staffing hours by tracking who is working and when. If you can get in the habit of overseeing the movements of your staff in live time, you will be more prepared to regulate who is working and plan accordingly when the requirements come into full effect. Regarding the 24/7 RN requirement, it will be important to act proactively by reanalyzing and redistributing your staffing hours to see better where your facility falls short.

The 24/7-hour rule will take effect two years after the final rule is published for urban facilities and three years for rural facilities, so the time is now to get all your papers in order.

While the new CMS mandates are not yet rigid, it behooves facility operators to prepare for the changes now.

We want to hear from you! Let us know how you feel about these new mandates with a comment below. 

COVID-19 cases have begun to climb as we head into flu season.

The majority of new cases are a result of transmission from asymptomatic and presymptomatic individuals that, thanks to less testing locations and less prudency, are elevating the dangers for high-risk populations. Many healthcare policies that emerged as a result of the COVID-19 pandemic are being dropped, raising concerns about the well-being of senior care staff and residents. Wearing an FFP2 mask has remained obligatory across many healthcare facilities globally and with great reason. There is countless data that supports the continued use of masks, namely in the reduction of active cases and overall morbidity rate. Despite most healthcare facilities across the United States dropping their mask mandates, there has been some pushback.

Several public health experts are advocating for year-round masking, masking during flu season, or masking when respiratory viruses reach their “critical threshold” should be mandatory healthcare policies in settings with high-risk populations. The SARS-CoV-2 pandemic has certainly garnered an elevated appreciation and understanding of health protocols that keep residents, patients, and healthcare workers alike safe. While community immunity and access to countermeasures have leveled out to some extent, older adults and those with underlying health conditions continue to represent the majority of new cases and based on observed trends, the same can be expected in the future.

While COVID-19 has been demoted to endemic, it is still disproportionately affecting our most vulnerable populations. Those in senior care are especially high-risk due to having more points of contact. Many facilities already have a vaccination process for their residents since vaccinating against the flu (and COVID, if not up to date) in advance of the upcoming season has proven to dramatically decrease the length and strength of respiratory illnesses.

According to the CDC, exposure to COVID-19 no longer requires isolation unless you have symptoms.  The CDC website has a new tool where you can type in the date of exposure, then, based on a number of factors, it can help you decide when to test or isolate. For more information about the upcoming Flu and COVID season, please check out the CDC data tracker.

You can also follow these guidelines provided by the CDC if you test positive: 

Any positive COVID-19 test means the virus was detected, and you have or recently had an infection.

• Isolate and take precautions, including wearing a high-quality mask or respirator, to protect others around you from getting infected.
• Tell people you had recent contact with that they may have been exposed.
• Monitor your symptoms. If you have any emergency warning signs, seek emergency care immediately.
• Contact a healthcare provider, community health center, or pharmacy to learn about treatment options that may be available to you. Treatment must be started within the first few days to be effective.