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.
  
  

As seen in McKnight's article, CMS: Educate, vaccinate and be ready to prove it, Centers for Medicare & Medicaid Services (CMS) will start enforcing their Interim Final Rule for COVID-19 Vaccination the week of June 14. Officially effective May 17, CMS is motivated to get staff vaccination rates up to 75 percent. Here's what's expected for both residents and staff.

1. Offer COVID-19 vaccines
2. Educate on COVID-19 and document efforts
3. Report COVID-19 vaccines and therapeutic treatments each week to the National Health and Safety Network (NHSN) 

The data collected will also be posted on the agency’s COVID-19 Nursing Home Data website as soon as possible, likely in mid-June.

Said Evan Shulman, CMS’ director for its Division of Nursing Homes, "For starters, let’s remember that the intent of this is to get as many people vaccinated as quickly as possible." He continued, "So, we will likely start prioritizing those individuals who are not vaccinated and start asking them how they were educated and if they were offered the vaccine.”

In other words, your first priority should be reporting who has received the vaccination, as those who aren't even achieving that goal are likely to be targeted first for audits. Next up, make meaningful attempts to educate residents and staff on vaccine safety – and track these efforts. Following are some educational resources that may be of help.

Webinars & Training

• COVID-19 vaccine safety monitoring - World Health Organization (WHO)
• AHA’s Newest COVID-19 Vaccine Confidence Resources Include Video, Webinar and Infographic - American Hospital Association (AHA)
• COVID-19 Vaccination in Long-Term Care: Safety, Efficacy, and Residents’ Rights - NursingHome411.org
• Vaccination for COVID-19 QuickPATH - Pathway Health

Videos

• Is the COVID-19 Vaccine Safe? - National Institutes of Health (NIH)
• 9 COVID-19 Myths Debunked - Cleveland Clinic
• Your COVID-19 vaccine questions answered - Mayo Clinic
• COVID-19 Vaccines: How Do We Know They Are Safe? - U.S. Department of Health and Human Services (HHS)

Centers for Disease Control and Prevention (CDC) Resources

• Tips for Building Confidence in COVID-19 Vaccines Among Patients
• COVID-19 Vaccination Communication Toolkit
• COVID-19 Vaccination Training Programs and Reference Materials
• Importance of COVID-19 Vaccination for Healthcare Personnel

Other Resources

• Invest in Trust: A Guide for Building COVID-19 Vaccine Trust and Increasing Vaccination Rates Among CNAs- Agency for Healthcare Research and Quality
• Patient education: COVID-19 vaccines - UpToDate.com Doctor Team
• COVID-19 vaccines: Get the facts (Q&A) – Mayo Clinic

In related news, long-term advocates encourage senior living caregivers to begin planning for the possibility of giving COVID-19 boosters. If you don't already have a good grip on vaccination tracking, know that technology can help. Our primeVIEW facility dashboard now has the ability to track which residents have received COVID-19 vaccinations.

AHCA/NCAL's participation in the Senate Finance Committee hearing, 'A National Tragedy: COVID-19 in the Nation’s Nursing Homes,' drew focus to the Care for Our Seniors Act, introduced in a press release and member webinar this past Monday.

In his testimonial, Chief Medical Officer David Gifford, MD, explained how reimbursement gaps between residents' cost of care and what providers are paid directly impact a nursing home's workforce. Workforce is just one of the four core areas for reform in the act.

Additional points made by Dr. Gifford to lawmakers included these:

• The most meaningful way to improve care is by focusing on infection control and increasing workforce availability
• Addressing poor nursing home care means incentivizing better care and increasing the number of staff at each bedside 
• If nursing homes can't improve with appropriate assistance, they shouldn't continue to operate

Most importantly, he stressed that because LTC providers rely almost entirely on government reimbursement, their support is needed to make it happen. 

What is the Care for Our Seniors Act?

In short, AHCA/NCAL and LeadingAge are joining forces to help long-term care (LTC) providers reform in four major categories:

• Clinical – enhance the quality of care
• Workforce – strengthen and support frontline caregivers
• Oversight – improve systems to be more resident-driven
• Structural – modernize for resident dignity and safety

Why Now?

As evidenced by AHCA/NCAL's participation in the hearing, COVID-19 shone a light on long-standing challenges for LTC to include:

• Workforce shortages
• Aging physical plants
• Underfunded government reimbursements

Now that the industry has our government's attention, the hope is that it will receive the funding needed to support these critical reform initiatives.

what Does reform really mean?

Upon securing government funding, AHCA/NCAL and LeadingAge hope to reform the LTC industry as explained below. 

Clinical Goals

Equip each nursing home facility with:

• Enhanced Infection Control Preventionist 
• 24-Hour RN
• Minimum PPE Supply (30-day average conventional use)

Workforce Goals

Implement a multi-phase approach to supply, attract and retain facility workforces, including:

• Student loan forgiveness and scholarships
• Tax credits for licensed LTC health care workers
• Housing and childcare assistance
• National, LTC-targeted campaign to increase the supply of nurse faculty/RNs
• Pathway for temporary nurse aides to become CNAs
• End to CNA training ban
• Expedited LPN-to-RN bridge programs

Oversight goals

• Improve surveys
• Address chronic poor performing facilities
• Monitoring customer satisfaction of residents and families

Structural goals

• Upgrade outdated HVAC
• Drive national study and funding to support a transition to private rooms

What's Next

AHCA/NCAL and LeadingAge can continue to use opportunities like last week's Senate Finance Committee hearing to advocate. So, get ready for reform. Think about how changes in surveys and the addition of customer satisfaction to star ratings might change your world. If you don't have ready access to clinical, staffing and census data for monitoring performance, we can help. 

Care for our senior act Resources

• Care for Our Seniors Act - Full Provisions
• Care for Our Seniors Press Release
• AHCA/NCAL Member Webinar Resources
• Provider Magazine: Workforce Crisis in SNFs Points to Need for Greater Reimbursement

CareChoice Cooperative Selects primeVIEW Dashboard to Help Non-Profit Senior Care Communities Optimize Operational Performance

[PRWeb] Duluth, GA, March 11, 2021 – Prime Care Technologies, Inc. today announced CareChoice Cooperative has adopted the primeVIEW decision-driven dashboard, providing its 18 members representing 31 non-profit communities with a powerful tool to sharpen operational performance. Utilizing the collective, actionable data in primeVIEW equips operators to make proactive, expedited decisions that directly impact resident care.

Integrating and aggregating data directly from electronic health records and other core information systems, primeVIEW offers a single analytics dashboard that transforms the way organizations make decisions. One simple login delivers a multi-dimensional view of facility performance, empowering leaders to drive productivity using critical benchmarks, rankings and trends.

CareChoice and Prime Care will also work together on member enhancements to primeVIEW that surgically address the needs of non-profits. These enhancements include a cost-of-care tool, clinical trending visualizations, a clinical risk scoring matrix and the ability to document case management.

“CareChoice is building a 'next generation' post-acute care organization designed to support nursing facilities and related services in value-based payment arrangements with market partners," said Bill Knutson, CareChoice CEO. We see this integrated data platform as an essential tool that will drive performance improvement and advance development of the new CareChoice Clinically Integrated Network.”

PrimeVIEW is a cloud-based application that brings together census, staffing, revenue, clinical, and Five-Star quality ratings into one decision-making platform. Data is constantly refreshed, providing near real-time views of operational performance.

“CareChoice has a mission to provide financial and operational benefits to its members through innovation and collaboration,” said Prime Care Technologies CEO Jim Hoey. “Putting our primeVIEW decision dashboard into the hands of its facility operators delivers on this promise.”

About Prime Care Technologies
Since 2003, Prime Care Technologies has provided senior care operators with integrated business intelligence and software solutions, driving proactive decision-making and the highest quality care. Based in Atlanta with 175 employees and 200+ healthcare/IT partnerships, its technology-driven solutions are installed in 6,500+ facilities. With deep multi-vendor interoperability expertise, including the integration of 70+ healthcare applications and 3,500+ EDI payers, Prime Care Technologies offers the leading data warehouse in post-acute care. Learn more at primecaretech.com.

About CareChoice Cooperative
Organized in 1996, CareChoice Cooperative is the nation’s first senior care cooperative formed by nonprofit, mission-driven providers of aging services. There are 21 Member organizations in CareChoice representing 43 nursing homes primarily located in the Minneapolis/Saint Paul metropolitan region. In addition to nursing facilities, many Members offer senior living options such as assisted living, independent living and memory care units. Some Members also operate Medicare-certified Home Health Care, therapy and hospice programs in their communities. Learn more at carechoicemn.org.

Set Your New Operations Strategy

Take your community through and beyond the pandemic with expert advice from Health Dimensions Group CEO/Principal, Erin Shvetzoff Hennessey (MA, NHA, CPG). She will provide a brief overview of COVID-19's impact on senior care, the rebound predictions, and strategies to help you adapt to new realities. 

In addition to offering strategic senior care consulting, HDG manages more than 40 communities, which utilize our primeVIEW business intelligence dashboard. Our Senior Director of Customer Success, Debi Damas (RN), will offer a brief preview of primeVIEW at the end of the webinar.

Agenda

1:00 PM - INTRODUCTIONS with Debi

HDG guest speaker Erin Shvetzoff Hennessey actively advocates for aging populations, is a 2019 Argentum Senior Living Leader Under 40, and is on the LeadingAge Minnesota board of directors

1:10 PM - REPOSITIONING POST-PANDEMIC with Erin

A brief overview of COVID's impact on senior care, the rebound predictions, and strategies to help you adapt to new realities

1:40 PM - HOW TECHNOLOGY CAN HELP with Debi

Our primeVIEW KPI dashboard brings together timely, decision-driven data to help you proactively impact census, labor, clinical and financial performance.

1:50 PM - Q&A with Attendees

Text questions to our experts using the webinar console and get the answers you need to sharpen your operational focus.

Don't let COVID fatigue get to you. This is your chance to set an operations strategy that takes your community forward to the next chapter.

Until then, be sure to check out our COVID-19 Partner Resource Library with free resources from partners like HDG. And, stay tuned for their latest blog.