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NIC Expert Says Occupancy Will Evolve as Owners, Operators Look for Recovery<p><em>Provider</em> posed a series of questions to Beth Burnham Mace, chief economist and director of outreach at the National Investment Center for Seniors Housing &amp; Care (NIC), on issues tied to the COVID-19 pandemic and occupancy levels across the seniors housing sector.<br><br class="ms-rteForeColor-1"><em class="ms-rteForeColor-1"><strong>Provider&#58;</strong></em> What is the current trend for occupancy, and which of the market segments is showing the most negative impact from the pandemic?<strong class="ms-rteForeColor-3"><br></strong></p><p><strong class="ms-rteForeColor-3">Mace&#58; </strong>The distinction between nursing care/skilled nursing and seniors housing is especially important to consider in discussing occupancy performance because the frailest elderly are often patients of skilled nursing’s higher acuity setting with around-the-clock nursing attention. And, it has been these elderly patients with significant pre-existing conditions that have seen the highest rates of COVID-19 incidence and fatalities. &#160;<br></p><p>Partially as a result, according to data from the NIC MAP® Data Service, the occupancy rate for skilled nursing properties fell more than other segment types with a 6.5 percentage point decline from the first quarter to 80.2 percent in the second quarter of 2020.<br></p><p>This was significantly more than the 2.8 percentage point drop in seniors housing properties to 84.9 percent, and when the aggregated seniors housing category is broken down into its subcategories, there was a 3.2 percentage point decline seen in assisted living properties to 82.1 percent and a 2.4 percentage point decline in independent living properties to 87.4 percent from the first to second quarters.<br><span><br class="ms-rteForeColor-1"><em class="ms-rteForeColor-1"><strong>Provider&#58;</strong></em> </span> A big if, but if the pandemic is under control and vaccines available to all, what do you expect the occupancy outlook to be once this terrible time abates? <span><strong class="ms-rteForeColor-3"><br></strong></span></p><p><span><strong class="ms-rteForeColor-3">Mace&#58; </strong></span> As you point out, the pandemic holds the cards. At this point, the outlook for the sector is tied to the path of the pandemic, its infection and penetration rate within properties, and the impact of the pandemic on broad economic growth. The seniors housing and nursing care industry as well as the broader national economy will be negatively affected by the COVID-19 virus until a vaccine is available and widely distributed. <br></p><p>And, whenever that happens, I do not believe that we will go back to business-as-usual. I believe that there is a transformational change in the seniors hosing and care industry and that the change will continue to evolve. Occupancy will eventually return to pre-pandemic levels, but the industry will be changed.<br><span><br class="ms-rteForeColor-1"><em class="ms-rteForeColor-1"><strong>Provider&#58;</strong></em> </span> And, we have the demographics to consider?<span><strong class="ms-rteForeColor-3"><br></strong></span></p><p><span><strong class="ms-rteForeColor-3">Mace&#58; </strong></span>&#58; Yes, more broadly, the underlying fundamentals and drivers of seniors housing remain in place. First, the demographics alone support the growing need for care and housing for seniors. Today, there are seven adult children aged 45 to 64 to care for every senior over the age of 80. By 2030, this ratio shrinks to 4&#58;1, and by 2050, it becomes 3&#58;1. Fewer caregivers suggest that community-based congregate settings will be needed more than ever. &#160;<br></p><p>Second, with nearly two of every three properties built before 2000, the inventory of senior housing properties is relatively old, and often a property refresh is needed for design, functionality, and efficiency. And, as obsolescence increases, new supply is needed at least in some markets. <br></p>2020-11-01T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/housing_2.jpg" style="BORDER&#58;0px solid;" />Management;COVID-19Patrick Connole​Provider posed a series of questions to Beth Burnham Mace, chief economist and director of outreach at NIC, on issues tied to the COVID-19 pandemic and occupancy levels across the seniors housing sector.
Coalition Works to Avert Major Medicare Payment Cuts<p>An effort to protect Medicare payments to long term and post-acute care providers continues on Capitol Hill and in official Washington, according to a source with the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), who says the Calendar Year (CY) 2021 Medicare Physician Fee Schedule Rule is a top priority.<br></p><p>Daniel Ciolek, associate vice president for therapy advocacy at AHCA/NCAL, says the proposed rule has been out of mind for many providers due to the attention required for battling the COVID pandemic. If finalized, he says the rule could result in significant payment cuts in 2021 for Part B therapy and other cuts to skilled nursing facility (SNF) physicians and portable X-ray providers that may impact the service residents in SNFs may receive.<br></p><p>The proposed cuts could also negatively impact assisted living (AL) communities and access to care for residents with intellectual/developmental disabilities (ID/DD).<br></p><p>For more than a year, Ciolek says AHCA/NCAL has worked with a coalition of 47 provider organizations to head off the cuts with the Centers for Medicare &amp; Medicaid Services (CMS). In addition, the coalition has worked on the issue with Congress since part of the problem with the proposed rule is a result of statutory budget-neutrality restrictions.<br></p><p>“We recognize that part of the problem is that statutory budget neutrality limits placed on the Medicare Part B physician fee schedule payment methodology create a situation that CMS is forced to ‘rob Peter to pay Paul,’” he says.<br></p><p>By way of background, in the CY 2020 Physician Fee Schedule (PFS) Final Rule (84 FR 62568), CMS finalized broad changes related to physician evaluation and management (E/M) services to reduce administrative burden, improve payment rates, and reflect current clinical practice.<br></p><p>The health care community supported restructuring and revaluing the office-based E/M codes, which will increase payments for primary care and other office-based services. Unfortunately, by law, any changes to the PFS cannot increase or decrease expenditures by more than $20 million. To comply with this budget-neutrality requirement, any increases must, therefore, be offset by corresponding decreases, Ciolek says.<br></p><p>As reflected in Table 90 of the proposed rule, payments for common PFS services furnished to residents in SNF, AL, and ID/DD residences will be cut 9 percent for physical therapy (PT) and occupational therapy (OT) services and 6 percent for portable X-ray services. In addition, the proposed rate tables for individual procedures indicate that speech language pathology (SLP) services as well as physician E/M services furnished to SNF residents will be cut up to 11 percent.<br></p><p>Speaking on the overall payment cut proposal, Ciolek says AHCA/NCAL realizes that in asking for the changes, CMS wants to improve the fairness of payments to physicians who manage patients with complex conditions in their offices.<br></p><p>“However, the solution, especially during a worldwide pandemic that most impacts patients in our AHCA/NCAL member facilities that are older and have multiple comorbidities, is not to cut payments to providers including physicians, portable X-ray providers, and therapists who furnish care to these individuals,” he says.<br></p><p>Ciolek adds that the association and coalition are hopeful that CMS will be responsive to the massive number of submitted comments from 42,640 provider and consumer stakeholders as well as members of Congress and put a pause on the planned payment cuts.<br></p><p>“While CMS may be able to offer some relief in the upcoming Final Rule, Congress will need to step up to the plate to fix this permanently,” he says.<br></p>2020-11-01T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/1120_news1.jpg" style="BORDER&#58;0px solid;" />Capitol HillPatrick Connole​An effort to protect Medicare payments to long term and post-acute care providers continues on Capitol Hill and in official Washington.
AHCA/NCAL Elects Boards for 2020-2021 Term; Meade and Crunk Remain Chairs<p>​The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) have elected AHCA’s Board of Governors and NCAL’s Board of Directors for the 2020/2021 term, confirming Debbie Meade of Georgia’s re-election as AHCA chair and Helen Crunk of Nebraska’s re-election as NCAL chair. <br></p><p>“I am proud to work alongside these extraordinary titans in our sector,” said Mark Parkinson, president and chief executive officer (CEO) of AHCA/NCAL. <br></p><p>“This has been our most challenging year, and their leadership is critical as they guide us through this unprecedented time.”<br></p><p>New AHCA Board members include Randy Bury, CEO of the Evangelical Lutheran Good Samaritan Society; Sarah Schumann, vice president of operations at Brookside Inn; and Heath Boddy, president and CEO of the Nebraska Health Care Association and president of the Affiliated State Health Care Association Executives (ASHCAE).<br>Members of AHCA’s 2020-2021 Board include&#58; <br></p><ul><li><img src="/Breaking-News/PublishingImages/740%20x%20740/1120DebbieMeade.jpg" alt="Debbie Meade" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;230px;height&#58;230px;" />Debbie Meade of Health Management (Georgia), AHCA Chair</li><li>Phil Fogg of Marquis Companies (Oregon), AHCA Vice Chair</li><li>Phil Scalo of Bartley Healthcare (New Jersey), Secretary/Treasurer</li><li>J. Mark Traylor of Traylor Porter Healthcare (Alabama), Independent Owner Representative</li><li>Steve Flatt of National Healthcare Corp. (Tennessee), Multifacility Representative</li><li>Randy Bury of The Evangelical Lutheran Good Samaritan Society (South Dakota), Not for Profit Representative</li><li>Derek Prince of HMG Healthcare (Texas), At-large Representative</li><li>Joe Mitchell of Summit Care (Florida), At-large Representative</li><li>Sarah Schumann of Brookside Inn (Colorado), At-large Representative</li><li>Julianne Williams of Dycora Transitional Health (California), At-large Representative</li><li>Chris Wright of iCare Health Network (Connecticut), At-large Representative</li><li>Helen Crunk of Pemberly Place Management &amp; Archer Place Medical Clinic (Nebraska), NCAL Representative</li><li>Heath Boddy of Nebraska Health Care Association (Nebraska), ASHCAE Representative</li><li>Betsy Rust of Plante Moran (Michigan), Associate Business Member (ABM) Representative; and</li><li>Michael Wylie of Genesis HealthCare (Pennsylvania), Immediate Past Chair.</li></ul><p>The NCAL Board of Directors welcomed newcomers Todd Dockerty, CEO of Dockerty Health Care Services; Stacy Hejda, vice president of regulatory compliance at Assisted Living Partners; and ASHCAE Vice President Jesse Samples of the Tennessee Health Care Association.</p><p dir="ltr" style="text-align&#58;left;"><img src="/Breaking-News/PublishingImages/740%20x%20740/1120HelenCrunk.jpg" alt="Helen Crunk" class="ms-rtePosition-2" style="margin&#58;5px 20px;width&#58;230px;height&#58;230px;" />The members of NCAL’s 2020-2021 Board of Directors include&#58;&#160;​</p><ul><li dir="ltr" style="text-align&#58;left;">Helen Crunk of Pemberly Place (Nebraska), Chair</li><li dir="ltr" style="text-align&#58;left;">Gerald Hamilton of BeeHive Homes of Albuquerque (New Mexico), Vice Chair</li><li dir="ltr" style="text-align&#58;left;">Mark Maxfield of The Cottages (Idaho), Secretary/Treasurer</li><li dir="ltr" style="text-align&#58;left;">Patricia Giorgio of Evergreen Estates (Iowa), Immediate Past Chair</li><li dir="ltr" style="text-align&#58;left;">John Bolduc of Odd Fellows’ and Rebekahs’ Home of Maine (Maine), At-large Representative</li><li dir="ltr" style="text-align&#58;left;">Rod Burkett of Gardant Management Solutions (Illinois), At-large Representative</li><li dir="ltr" style="text-align&#58;left;">Megan Campbell of IntegraCare Corp. (Pennsylvania), At-large Representative</li><li dir="ltr" style="text-align&#58;left;">Sue Coppola of Sunrise Senior Living (Virginia), At-large Representative</li><li dir="ltr" style="text-align&#58;left;">Ana de la Cerda of Aegis Living (Washington), At-large Representative</li><li dir="ltr" style="text-align&#58;left;">Todd Dockerty of Dockerty Health Care Services (Michigan), At-large Representative</li><li>Darryl Fisher of Mission Senior Living (Nevada), At-large Representative</li><li>Denise German of Medicalodges (Kansas), At-large Representative</li><li>Stacy Hejda of Assisted Living Partners (Iowa), At-large Representative</li><li>Barbara Mitchell of Magnolia Manor (Georgia), At-large Representative</li><li>Sean Mockbee of Sunshine Village (Arizona), At-large Representative</li><li>Gail Sheridan of Tealwood Care Centers (Minnesota), At-large Representative</li><li>Sarah Silva of Avamere Health Services (Oregon), At-large Representative</li><li>Elizabeth Wheatley of Five Star Senior Living (Arizona), At-large Representative</li><li>Doug Farmer of Colorado Health Care Association (Colorado), State Affiliate Representative</li><li>David Voepel of Arizona Health Care Association (Arizona), State Affiliate Representative; and</li><li>Shawn Scott of Medline Industries (Illinois), ABM Representative.<br></li></ul><p>The ex-officio members on the NCAL Board of Directors include Meade as the AHCA chair and Fogg as the AHCA vice chair, as well as ASHCAE Vice President Jesse Samples.<br></p><p>“This year’s NCAL Board incorporates leaders from across the nation that will go above and beyond to help our assisted living members succeed,” said Scott Tittle, executive director of NCAL. <br></p><p>“Now more than ever, we need strong individuals to lead us in this fight against COVID-19, and this group is prepared to do just that.”<br></p><p>Members of the AHCA Board of Governors are elected by the association’s governing body, the Council of States. The NCAL Board of Directors is elected by current members of the NCAL Board and by NCAL State Leaders.<br></p>2020-11-01T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/1120DebbieMeade.jpg" style="BORDER&#58;0px solid;" />Patrick Connole​AHCA/NCAL have elected AHCA’s Board of Governors and NCAL’s Board of Directors for the 2020/2021 term, confirming Debbie Meade of Georgia’s re-election as AHCA chair and Helen Crunk of Nebraska’s re-election as NCAL chair. 
SNFs Must Upgrade SAMS Level to Meet New COVID Test Requirements<p>Skilled nursing facilities (SNFs) are now required to report point-of-care (POC) test results performed under their Clinical Laboratory Improvement Amendment (CLIA) waiver to the National Healthcare Safety Network (NHSN) system, according to a COVID-19 update from the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).</p><p>This requires an upgrade from Secure Access Management Services (SAMS) Level-1 access to SAMS Level-3 access. <br>AHCA/NCAL urges SNFs to act immediately as this upgrading process can take up to four weeks. While this requirement is in effect now, AHCA/NCAL said it has been informed that enforcement discretion will be utilized until Nov. 20.   </p><p>Instructions on upgrading to SAMS Level-3 are available <a href="https&#58;//www.ahcancal.org/News-and-Communications/Blog/Pages/Updated-HHS-NHSN-Reporting-Requirements.aspx">here. </a></p><p>Assisted living communities can still report to either the state or NHSN to meet the POC test reporting requirement. However, if they choose to use NHSN they must upgrade to SAMS Level-3, AHCA/NCAL said.</p>2020-10-29T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/1020_News1.jpg" style="BORDER&#58;0px solid;" />COVID-19Patrick ConnoleAHCA/NCAL urges SNFs to act immediately as this upgrading process can take up to four weeks.