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.

Last week, our team attended the annual Ohio Health Care Association (OHCA) convention. Our Senior Customer Success Director Debi Damas also lead a session on the state of senior care. She discussed pandemic challenges and encouraged the exchange of strategies to mitigate change. The following is a recap of this valuable session.

Where does senior care stand and what the heck happened?

• Nursing home staffing shortages only worsened as 2020 came to a close
• 48 states saw occupancy of 80% or less, with some as low as 56%

What can senior organizations do right now?

• Develop purpose-driven, compassionate staff
• Adopt technology to increase connectedness, efficacy, and optimal health
• Embrace telehealth
• Develop a culture of positive aging framed by wellness
• Establish trust by being prepared for emergencies and unexpected events

What happened with senior living census?

• Increased push to home health care
• People wanted no part of facility-based care
• Long-term care (LTC) facilities were not admitting
• Skilled nursing facilities (SNFs) turned beds/halls into COVID units
• Senior care providers are now seeing slight increases in census

How can senior organizations build census?

• Marketing value-adds to prospective residents:
• Amenities
• Telehealth
• Wellness focus
• Sharing positive performance data with hospitals:
• Vaccination rates
• Infection control
• Outcome data, readmission rates
• Identifying an ideal niche based on ICD code(s)

How does revenue look in senior care?

• 55% of SNFs are operating at a loss
• Significant increases in claims denials, resulting in more reviews
• Some managed care is moving from PDPM to levels
• Per Mark Parkinson (CEO of AHCA/NCAL), long term success comes down to: 
• State Medicaid rates
• Payer mix
• Financing
• Operational excellence

What staffing trends emerged among senior care employers?

• Rigid schedules/Inflexible call off policies
• 23% of nursing homes had direct care staff shortages in May
• 96% received some government assistance
• 47% received funds from Paycheck Protection Plan (PPP)
• 82% received funds from CARES Act/Provider Relief Fund
• 52% received Medicaid add on or increase from state government

What can senior care organizations do to improve staffing?

• Increase the ways you make staff feel valued
• Change your pay structure
• Offer bonuses – sign-on, working all scheduled shifts, etc.
• Revise staffing policies to benefit employees
• Increase flexibility to accommodate child/eldercare challenges
• Provide a career path; demonstrate benefits of added skills and education
• Be attentive and thorough with screening and hiring
  

To reiterate one of Debi's earlier points, technology can help. Here are three senior care providers who are benefiting right now from our software.

• Embassy Healthcare saves $1.5M in labor with primeVIEW App
• Symphony Care Network increases revenue $1,200/stay with Managed Care MASTER app
• Hyatt Family Facilities rely on primeVIEW app to consolidate data for monitoring Five Star and PBJ reporting

Recently, CEO Jim Hoey and Sales VP Jae Sparks attended Reimbursement-Con by Zimmet Healthcare. CMS' Patient-Driven Payment Model (PDPM) was a hot topic, with speakers offering strategies for skilled nursing facilities (SNF) to maximize reimbursement.

To fully appreciate these strategies, let's back up to what we know, what we expect, and some wildcards with PDPM. 

What We Know

• PDPM was the biggest overhaul in SNF payments in a generation.
• PDPM was supposed to be budget neutral.
• Before the March 2020 public health emergency, experts said PDPM was more generous than CMS intended. 

What We Expect

• CMS wants $1.7 billion back, which could mean a 5% recalibration.
• Using average daily rates in a post-pandemic world could cause a larger recalibration next year, more like 10-12%.

The Wildcards

• CMS did not compensate SNFs for COVID care until April 1, 2020.
• CMS assumed all SNFs were affected by COVID in the same way.
• ACOs and value-based purchasing are forcing shorter lengths of stay with sicker patients.
• Due to transitional care units, hospitals are seeing most of the PDPM benefits.

While legislators seek reform, SNFs must still try to survive in the PDPM world. To this point, speakers discussed the best practices. An overriding theme here was using Interim Payment Assessments (IPAs). Only 3% of SNFs are, and it's to your disadvantage.

IPAs

• CMS wants IPAs to help SNFs track the status of a patient’s conditions and needs for a higher level of care.
• The purpose of IPAs is to establish a payment rate or billing code for billing Medicare Part A.
• Implement IPAs when a resident condition changes and may last 14 days or more.
• Conduct IPAs as a routine when resident stays hits day 21; a lot can change in three weeks.

Other Suggestions

• Offer specialty care and therapy, like speech and language.
• Stress the importance of documenting all work, using multiple documenters, where possible.
• Correct coding, correct coding, correct coding; billers may need refresher courses.
• Applaud payers when they do the right things, but never take that as enough.

Technology can help.

• Our primeVIEW and Managed Care MASTER solutions allow you to customize alerts on certain clinical conditions or changes that should trigger staff to conduct an IPA. 
• Our primeCLAIMS solution makes coding and editing simple and its backed by a support team experienced in post-acute billing.
  
  

In Feds to deliver ‘positive news’ on Provider Relief Fund in coming days: Parkinson, McKnight's LTC News summarized recent comments from AHCA President and CEO Mark Parkinson at the Synergy Summit in Utah.

Among other things, Parkinson stressed managed care is not going away and encouraged senior care providers to embrace it by:

• Becoming a top provider in a given market
• Improving demographics
• Becoming part of a network
• Taking advantage of institutional special needs plans (I-SNPs)

Naturally, you may want to know more about I-SNPs and if/how you might take advantage of them. The below Q&A may be of help to you in assessing this.

What is an I-SNP?
I-SNP stands for Institutional Special Needs Plan and is designed for those who will live in a long-term setting for 90 days or more with no immediate plans for discharge

How does it fit within Medicare?
An I-SNP is a Medicare Advantage plan focused on the care of specialized populations. It replaces traditional Medicare to cover inpatient and outpatient services, plus prescription drugs (as a Part D service).

Who is eligible for an I-SNP?

• Reside in a long-term care facility with no anticipated discharge
• Currently enrolled in Medicare A/B
• Live in a county where I-SNP is licensed

*Check CMS' Special Needs Plan (SNP) Data to see who is operating in your state.

What are the highlights of an I-SNP?

• Nurse practitioners provide preventative and proactive care
• RN case managers coordinate care according to the Model of Care (MOC) required by CMS
• Residents are assigned a 'Risk for Hospitalization' level, which determines care plan and a schedule for proactive rounds
• Rounds occur as often as weekly or can be more frequent for high-risk residents
• Provider visits are not subject to medical necessity requirements of traditional Medicare, so they can be more proactive and frequent

How do I-SNPs benefit SNFs/residents?

• Increased provider visits; faster identification of conditions/treatment
• Treatment-in-place advantage – visits can happen in the nursing facility
• Proactive and preventative care; prevents unnecessary hospitalizations
• Reduce risks and stress associated with hospital stays

How can technology help facilities with I-SNPs?

• Case-to-contract management is essential to following an ISNP
• Our Managed Care MASTER software brings contracts online, PLUS pairs them with best-practice workflows and alerts
• With this automation, you can easily train anyone to act as a case manager and ensure reimbursement

If our Managed Care MASTER can help you 'manage' your managed care, including I-SNP contracts and care, let's connect.

Prime Care Technologies is pleased again to help sponsor the LTC 100 Leadership Conference. This year’s theme –Carpe Diem - Roadmap to Reinvention – reflects the changing LTC landscape and your need to provide quality, value-based outcomes, while also succeeding as a business.

As a 15+ year post-acute technology provider, we know the ropes. Join us to see how we are solving operational pain points with our comprehensive post-acute claims and managed care reimbursement solutions. You'll see how our technologies are evolving with PDPM and Five Star, too. 

If it's easier, pick a time to connect!