Evaluating PDPM Clouded by Changes Resulting from COVID-19 Pandemic<p>​A new report by Avalere Health examining the impact of the changes resulting from the transition to the Patient-Driven Payment Model (PDPM) said more time and data are needed before any conclusions can be made on the impact of the new payment system due to the COVID-19 pandemic.<br></p><p>“The roll-out of the PDPM in October 2019 followed quickly by the COVID-19 pandemic presents challenges to understanding the extent to which increases in payment to skilled nursing facilities [SNFs] are due to the changes in the payment system versus changes in the patient populations served during the COVID-19 pandemic,” Avalere’s report said.<br></p><p>“Given the confounding effects of the pandemic and the new payment system, it is important to collect more data before evaluating the transition to the PDPM.”<br></p><p>The study comes at a time federal regulators are considering possible adjustments to the PDPM budget neutrality factor, which the report said are likely skewed by the impact of the pandemic on nursing home population shifts. A proposed adjustment from the Centers for Medicare &amp; Medicaid Services (CMS) would reduce PDPM payments to SNFs. <br></p><p>In reaction to the report, Mark Parkinson, president and chief executive officer of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), said, “Without sufficient data prior to COVID-19, now is not the time to introduce another change to PDPM.&#160;Nursing home providers need reimbursement stability so they can remain focused on resident safety and quality care as they attempt to recover from the pandemic.”&#160; &#160;<br></p><p>As background, Avalere noted that Fiscal Year (FY) 2020 was the first year of the new PDPM that CMS developed for SNFs. CMS designed PDPM to be budget neutral relative to payments under the previous Resource Utilization Groups Version IV (RUG-IV) payment system, report authors said. <br></p><p>“To maintain budget neutrality, any observed increases in payment under PDPM in FY 2020 are subject to a downward adjustment in future rates. In its assessment of budget neutrality, CMS estimated FY 2020 RUG-IV payments to be 5.3 percent higher than FY 2020 PDPM payments,” the report said. <br></p><p>“After removing patients with a COVID-19 diagnosis on a SNF claim, CMS found that the difference was 5.0 percent, attributing the 0.3 percent difference to increased spending to treat COVID-19 patients.” <br></p><p>In its study, Avalere conducted an analysis to evaluate the comprehensive impact of the COVID-19 pandemic on SNF patients. Avalere used the Minimum Data Set (MDS) to analyze the percentage of patients with a respiratory diagnosis treated in SNFs in FY 2019 versus FY 2020. <br></p><p>Avalere’s analyses also examined changes in patient case-mix by month to determine how COVID-19 may have impacted payments for SNF care over the course of the pandemic. This month-by-month analysis also allows for an understanding of how government-mandated changes to patient management and SNF operations may have affected Medicare payments for SNF care for COVID-19 and non-COVID-19 SNF patients.<br></p><p>From this examination, Avalere found that March 2020 marked the start of the COVID-19 pandemic in terms of the larger impact on the health care system, Avalere’s analysis of MDS assessment items for respiratory diagnoses (MDS Items I6200 and I6300) found a higher proportion of patients with respiratory diagnoses throughout FY 2020 relative to FY 2018 and FY 2019.<br></p><p>Guidance from CMS on COVID-19 diagnosis coding was not available to SNFs until March 2020,&#160;but researchers said respiratory diagnoses in SNFs were significantly higher in all of FY 2020 compared to prior years.<br></p><p>“While several factors may contribute to the higher rates of respiratory illness, it is conceivable that this sharp increase was driven in part by COVID-19 cases before CMS instituted a formal COVID-19 diagnosis code and by undiagnosed cases throughout the year,” the report said.<br></p><p>This finding suggests that CMS’ claims-based approach using the COVID-19 diagnosis code may not have adequately captured the COVID-19 case volumes over the course of the pandemic, Avalere said.<br></p><p>In addition to looking at the respiratory diagnosis items on MDS, Avalere also examined the ICD-10 diagnosis coding on MDS assessments and found that 10.3 percent of patients treated in SNFs had a diagnosis for COVID-19 over the course of FY 2020, with the highest number of cases occurring in April and May 2020.<br></p><p>Read the full report at <a href="https&#58;//avalere.com/insights/covid-19-pandemics-considerable-impact-on-skilled-nursing-facilities" target="_blank">COVID-19 Pandemic’s Considerable Impact on Skilled Nursing Facilities | Avalere Health</a>.<br></p>2021-06-16T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/staff_laptop_2.jpg" style="BORDER&#58;0px solid;" />COVID-19Patrick Connole​While designed to be budget neutral, more time and data are needed to evaluate how PDPM has been impacted by the pandemic.
Bipartisan Group of Senators Reintroduces Observation Stay Legislation<p>​​Sens. Sherrod Brown (D-Ohio), Susan Collins (R-Maine), Sheldon Whitehouse (D-R.I.), and Shelley Moore Capito (R-West Va.) have reintroduced their bipartisan legislation to update a current loophole in Medicare policy that would help protect seniors from high medical costs for the skilled nursing care they require after hospitalization.</p><p>The Improving Access to Medicare Coverage Act would allow for the time patients spend in the hospital under “observation status” to count toward the requisite three-day hospital stay for coverage of skilled nursing care. Rep. Joe Courtney (D-Conn.) is the lead sponsor of bipartisan companion legislation in the House of Representatives. The other House sponsors are Suzan DelBene (D-Wash.), Ron Estes (R-Kansas), and Glenn Thompson (R-Pa.).</p><p>Under the current Medicare policy, a beneficiary must have an “inpatient” hospital stay of at least three days in order for Medicare to cover post-hospitalization skilled nursing care. Patients that receive hospital care under “observation status” do not qualify for this benefit, even if their hospital stay lasts longer than three days, according to the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), a supporter of the Improving Access to Medicare Coverage Act.</p><p>“Seniors should be able to focus on their recovery instead of billing technicalities and sky-high medical bills, or, worse yet, trying to recover without the medical care they need because they can’t afford it,” said Brown. “This legislation would improve access to the medical care seniors need and saves money on hospital readmission costs. It’s a simple fix and the least we can do to protect our seniors from outrageous medical costs that they have no control over.”</p><p>Collins said when seniors require hospitalization, their focus should be on their health and recovery, not on how they were admitted.<br>“The financial consequences of this distinction between an observation stay and inpatient admittance can be severe for seniors,” she said. “Our bipartisan bill would help insulate older Americans from undue out-of-pocket costs and ensure that they get the care that they need.”</p><p>Whitehouse added that seniors trying to recover shouldn’t have to worry about accessing the skilled nursing care they need. This bipartisan legislation would fix a quirk in the billing rules that forces patients into stressful and pointless long stays in the hospital, he said.</p><p>“West Virginia’s seniors shouldn’t have to pay more for their health care because of a technical loophole in our current Medicare law,” Capito said. “The Improving Access to Medicare Coverage Act is a commonsense bill to right this wrong and protect seniors while they’re recovering in the hospital and at their most vulnerable. This bipartisan effort would take a crucial step forward in improving access to care for our seniors.”</p><p>&#160;AHCA/NCAL said the nursing care profession backs the legislative effort in the Senate. “Our nation’s skilled nursing facilities are privileged to help America’s seniors receive the therapy and care they need after a hospital stay, but Medicare’s three-day hospital stay requirement is arbitrary and unfair,” said AHCA/NCAL President and Chief Executive Officer Mark Parkinson.</p><p>“Too many seniors are left to foot the bill for their post-acute care, all because their hospital stay was coded as under observation. They deserve the chance to recover without worrying about how they’re going to pay for it. We greatly appreciate Sens. Brown, Capito, Collins, and Whitehouse for leading this charge once again, and we urge Congress to swiftly pass this legislation,” he said. </p><p>Specifically, the bill would&#58;</p><p>•&#160;Amend Medicare law to count a beneficiary’s time spent in the hospital on “observation status” toward the three-day hospital stay requirement for skilled nursing care; and</p><p>•&#160;Establish a 90-day appeal period following passage for those that have a qualifying hospital stay and have been denied skilled nursing care after Jan. 1, 2021.</p><p>The Improving Access to Medicare Coverage Act has been <a href="https&#58;//www.brown.senate.gov/download/reintroduce-bipartisan-legislation-to-protect-seniors-high-costs-medical">endorsed by more than 30 organizations, </a>including&#58; AARP, Alliance for Retired Americans, American Case Management Association, American Health Care Association, AMDA – The Society for Post-Acute and Long-Term Care Medicine, Center for Medicare Advocacy, LeadingAge, National Academy of Elder Law Attorneys, National Association of State Long-Term Care Ombudsman Programs, National Center for Assisted Living, National Committee to Preserve Social Security &amp; Medicare, National Consumer Voice for Quality Long-Term Care, and the Society of Hospital Medicine.&#160;</p>2021-06-15T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/capitol_moon_night.jpg" style="BORDER&#58;0px solid;" />PolicyPatrick ConnoleThe law would count time spent in the hospital on “observation status” toward the three-day stay requirement for skilled nursing care under Medicare.
HHS Extends Deadlines for Provider Relief Fund Recipients<p>In a move welcomed by the long term care profession, the Department of Health and Human Services (HHS) on June 11 <a href="https&#58;//www.hhs.gov/sites/default/files/provider-post-payment-notice-of-reporting-requirements-june-2021.pdf?cm_ven=ExactTarget&amp;cm_cat=COVID-19+Update+%23182+Clif&amp;cm_pla=All+Subscribers&amp;cm_ite=released&amp;cm_lm=pconnole%40ahca.org&amp;cm_ainfo=&amp;&amp;&amp;&amp;&amp;">released </a>updated reporting requirements for recipients of Provider Relief Fund (PRF) payments.</p><p>According to a summary by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), with this announcement, HHS expands the amount of time providers will have to report information, aims to reduce burdens on smaller providers, and extends key deadlines for expending PRF payments for recipients who received payments after June 30, 2020. </p><p>Some key updates include&#58;</p><p>•&#160;The period of availability of funds is based on the date the payment is received (rather than requiring all payments be used by June 30, 2021, regardless of when they were received).</p><p>•&#160;Recipients are required to report for each Payment Received Period in which they received one or more payments exceeding, in the aggregate, $10,000 (rather than $10,000 cumulatively across all PRF payments).</p><p>•&#160;Recipients will have a 90-day period to complete reporting (rather than a 30-day reporting period).</p><p>•&#160;The PRF Reporting Portal will open for providers to start submitting information on July 1, 2021.<br>Mark Parkinson, president and chief executive officer of AHCA/NCAL, said, “The extensions by HHS regarding the use and reporting of aid received through the Provider Relief Fund is welcome news to the long term care profession.”</p><p>He added that “we greatly appreciate the administration recognizing that our battle with COVID-19 is not over yet, and that our ongoing efforts require ongoing resources. We now strongly encourage the agency to distribute the remaining funds and to dedicate a significant portion to long term care, which has been the epicenter of the pandemic and now faces imminent closures without additional aid.”</p><p></p>2021-06-11T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0520_News1.jpg" style="BORDER&#58;0px solid;" />Policy;COVID-19Patrick ConnoleThe updated reporting requirements aim to reduce burdens on smaller providers.
New Study Examines Racial, Ethnic Disparities in Nursing Home Flu Vaccinations<p>A new study in the June issue of JAMDA examines racial and ethnic disparities in influenza vaccination among adults in nursing homes and what may factor into the statistical differences among these groups.</p><p>In “Decomposing Racial and Ethnic Disparities in Nursing Home Influenza Vaccination,” authors analyzed data for 630,373 short-stay and 1,029,593 long-stay nursing home residents. The researchers found that among short-stay residents, the proportion vaccinated against influenza was 67.2 percent for White residents, 55.1 percent for Black residents, and 54.5 percent for Hispanic residents.</p><p>The numbers were higher for long-stay residents, at 84.2 percent for White individuals, 76.7 percent for Black, and 80.8 percent for Hispanic.</p><p>Characteristics associated with decreased likelihood of influenza vaccination among short-stay residents included payer source, higher acuity index, percent of residents on an antipsychotic, and certified nurse assistant (CNA) hours per resident, the report said. </p><p>The authors noted that low vaccination rates may affect all individuals if ambulatory short-stay residents are able to move freely around the facility, potentially exposing others to respiratory illness.</p><p>In conclusion, the findings show that “measures associated with nursing home quality of care were important positive contributors to the disparity in influenza vaccination. Tracking vaccination rates in nursing homes to detect and intervene locally upon racial/ethnic differences may mitigate disparities until more detailed qualitative data is available to inform improvements to health care policy.”</p><p>The study was conducted by researchers at a number of domestic and international universities, including the Department of Health Services, Policy, and Practice, Brown University School of Public Health, and the Leslie Dan School of Pharmacy, University of Toronto, in Canada.</p><p><a href="https&#58;//www.jamda.com/article/S1525-8610%2821%2900299-1/fulltext">Click here </a>for more information about the study.<br></p>2021-06-11T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0220_News1.jpg" style="BORDER&#58;0px solid;" />CaregivingPatrick ConnoleRates are higher across the board for long-stay residents vs. short-stay patients.