[BLOG] Post Acuity Insights: Americans More Sick Than Ever, CMS Playing Jenga

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.