May 2020

Vol. 47 No. 5

May

Cover Story

Making it Work: Caregiving During a Pandemic

https://www.providermagazine.com/Issues/2020/May/Pages/Making-it-Work-Caregiving-During-a-Pandemic.aspx

Making it Work: Caregiving During a Pandemic

<div></div> <div> At the time this cover story was written, the nation had just entered into its second month of a federal and state lockdown of skilled nursing and assisted living facilities, along with intermediate care facilities for individuals with intellectual disabilities and many other aspects of life in America, in order to stem the spread of the highly contagious and deadly coronavirus (COVID-19). This article will not attempt to be the latest news on what has been the rapid evolution of a virus that has ravaged much of the world. Since first being reported as a significant health problem in late 2019 in Wuhan, China, COVID-19 has since spread in every direction, leading the World Health Organization to officially label the incurable virus a pandemic in March 2020.</div> <div> </div> <div>Instead, <em>Provider</em> will present a series of real-life snapshots from the front lines of the fight to save Americans from </div> <div> </div> <div><br></div> <div> </div> <div>COVID-19 infection. Affecting the elderly and immunocompromised the most, the virus has put long term and post-acute care (LT/PAC) providers on a war footing for months now, with no real end in sight. </div> <div> </div> <div><br></div> <div> </div> <div>Facilities are in lockdown, open only to the staff and essential personnel needed to care for residents and safely operate the buildings. Even families and friends are banned from the communities housing the very people most prone to not only get the infection, but also to see serious health consequences if COVID-19 <br></div> <div> </div> <div>strikes. </div> <div> </div> <div><br></div> <div> </div> <div>The following is a chronicling of <a href="/archives/2020_Archives/Pages/0520/NAVIGATING-THROUGH-THE-STORM-How-a-Profession-Deals-with-a-Pandemic.aspx" target="_blank" title="How a Profession Deals with a Pandemic">what providers have done to save lives,</a> build hope, and conduct themselves as professionals with a special mission under the most trying of circumstances. </div> <h2 class="ms-rteElement-H2"> Residents Come First</h2> <div>Deborah Meade, chief executive officer (CEO) of Health Management, based in Warner Robins, Ga., is seeing the COVID-19 pandemic from different perspectives as the leader of her company, an acting administrator in a facility, and chair of the American Health Care Association (AHCA). As all providers interviewed pointed out, resident safety is No. 1, and all work is choreographed around that. </div> <div><br></div> <div><img src="/Issues/2020/May/PublishingImages/DebbieMeade.jpg" alt="Debbie Meade" class="ms-rtePosition-1" style="margin:5px 15px;" />“Our priority is always to keep the environment for residents and staff safe,” says Meade. “Everything we’ve done with implementing different policies has been focused on that goal.”</div> <div><br></div> <div>Policies and guidance from the federal government for LT/PAC providers have changed almost daily, putting new demands on providers to not only stay on top of them but implement them with little notice. </div> <div><br></div> <div>Ongoing communication is not only critical but essential to help those on the front lines feel connected, says Meade. “I think the more that we can report, and educate, and talk about it helps,” she says. “It’s not easier, but maybe makes people feel better.”</div> <div><br></div> <div>The newest form of guidance to enhance resident safety when Meade spoke with Provider on March 15 was guidance from the Centers for Disease Control and Prevention (CDC) to restrict visitors. </div> <div><br></div> <div>“Sometimes we say the right decision can be the most difficult decision to make, and keeping residents from seeing their families and families from seeing the residents is extremely hard,” says Meade. “We’ve done a little of everything to help keep families connected.” </div> <div><br></div> <div>A little of everything means going beyond traditional phone calls, and Meade says her center now has a Facebook page that staff are using to post updates and photos. “Those pictures help put families at ease and show that yes, we’re still letting the residents have fun and keep some joy in the day when it can be quite frightening to them.”</div> <div><br></div> <div>At press time, by far the biggest challenge for Meade and her staff was restricting visitors. “It’s heartbreaking to tell someone that they can’t come in to see their loved one,” she says. “I have been very honest and very transparent—this is not a time that we hide and sugarcoat.”</div> <div><br></div> <div>The staff, she says, have been engaged as always, helping out where needed. “My staff have been wonderful; they’re always asking what else they can do and figuring out how they can best do it,” she says. “They are pulling together as always.”</div> <h2 class="ms-rteElement-H2">Disaster Preparedness Lessons</h2> <div>Meade and others agree that while nothing could truly prepare them for the enormity of COVID-19 and its daily changing nature, disaster preparedness certainly helped. “I’ve been a part of hurricane evacuations at a facility in Savannah, and the one thing you will always learn is any best laid plan is never going to go perfectly, so it’s good to have back-up measures in place,” Meade says. “The staff always pull together to work together, and their compassion for residents and each other means more now than ever before.” </div> <div><br></div> <div>Meade says there is a shortage of personal protective equipment (PPE), and that is a real concern. However, work is being done to address the shortage, with AHCA and the National Center for Assisted Living (NCAL) working together with the Centers for Medicare & Medicaid Services (CMS) and CDC to communicate needs.</div> <h2 class="ms-rteElement-H2">Early Steps</h2> <div>Even before it was made federal regulation, Meade says she instructed staff to begin restricting visitors. How she did it successfully had much to do with early and consistent communication. </div> <div><br></div> <div>“We pulled everybody together and met with all key personnel,” she says. Education on the decision to restrict visitors and why it was decided was crucial. “And then we had to make sure we were all saying the same thing; no one needed to give any different stories. Everyone has to say and give the same truthful story and be transparent and honest about the restrictions, which is always the best policy.”</div> <div><br></div> <div>Making sure the right message gets across all levels of staff is a key part in Meade’s facility’s daily meeting. “And we continue to talk during the day about those messages. At the daily meetings we also give everyone an opportunity to talk about what came up yesterday, what came out today, and we revisit it collectively to put the communication plan in place.”</div> <h2 class="ms-rteElement-H2">A Whirlwind</h2> <div>Tiffany Adams, RN, is staff development coordinator and infection preventionist at Hyden Health and Rehabilitation Center in Hyden, Ky., a role she has worked in since February. She had been a part of Hyden for years as a nurse assistant, then registered nurse, working on the floor. </div> <div><br></div> <div>She says things have been a whirlwind with new guidance to follow and implement, and everything has been focused on keeping residents safe and healthy. Restricting visitors means screening people outside, taking temperatures, and asking a series of questions on symptoms if present and exposure to individuals with COVID-19. </div> <div><br></div> <div>Adams and her team monitor residents on a regular basis, and they also monitor staff. “Every shift that comes in we ask questions and we take their temperatures,” she says. “When we get another shift in, we go ahead and take everyone’s temperature to make sure that we’re assessing for any respiratory issues.”</div> <div><br></div> <div>In terms of PPE, Adams says the staff assess equipment all the time. “We are trying to make the most of it, and we keep an eye on our supply, and we haven’t run into an issue yet,” she says. “It’s kind of real scary right now watching the news and everything that I’ve seen, but we’re trying to make sure that we are being cautious and making sure that we are not unnecessarily using the PPE when we don’t need it.”</div> <h2 class="ms-rteElement-H2"><br></h2> <h2 class="ms-rteElement-H2">Staff Education</h2> <div>Rosemary Oldham, RN, minimum data set coordinator at Hyden, is Adams’ predecessor, and she currently assists Adams with education of staff. The fast flow of all the changes has pushed Oldham and her colleagues into overdrive for processing the changes and turning around to provide education to staff. </div> <div><br></div> <div><img src="/Issues/2020/May/PublishingImages/RosemaryOldham.jpg" alt="Rosemary Oldham" class="ms-rtePosition-1" style="margin:5px 15px;" />She points out that even a small change in existing regulations and guidance from CDC, CMS, and other federal agencies, for example, is a big deal, and changes occur daily. “It’s coming from all different areas, and we have to put it all together and in what should be the best plan for our building,” she says.</div> <div><br></div> <div>Oldham has been flexible with her workload and put noncritical items to the side in order to allocate more time and resources to COVID-19. “Right now, we are really focused on our PPE and the N95 masks,” she says. “I’ve had to put some of my other work aside to really focus on this and to help educate the staff on all the changes.”</div> <div><br></div> <div>In terms of keeping staff updated and educated, Adams says she is learning while teaching. “I’m learning something new every day while I teach staff, too,” she says. “And other staff pitch in their time and help get everyone trained.” </div> <div><br></div> <div>Adams says she has even reached out by phone to some employees to ask them and make sure they understand what is being taught. “What’s also helpful is that we have the knowledge of what we must do if someone does become infected as far as quarantining and care for that person and others,” she says. “So, following up with staff on their understanding of all that’s happening and the daily changes is important.”</div> <div><br></div> <div>Hyden staff have reached out to other experts for help. “We’ve reached out to the local fire department, and the local emergency management service has been good about sharing information with us and helping us screen people,” she says. </div> <div><br></div> <div>The overall state of mind in staff is good, Adams says. “Everyone is doing really well with it, although there is a little bit of uneasiness because it’s something new that’s really scary. Everybody’s pitching in doing what we’ve got to do to take care of the residents.” </div> <div><br></div> <div>The morale of residents is also termed good, with many of them talking to friends or family via shared iPhones from staff and iPads at the facility. “FaceTime and Skype have become very popular around here,” says Adams. </div> <h2 class="ms-rteElement-H2">Companywide Communication</h2> <div>The Evangelical Lutheran Good Samaritan Society, based in Sioux Falls, S.D., keeps its staff abreast of COVID-19 changes in a multitude of ways, one being via daily calls companywide across its 270 facilities in 10 regions from its incident command center. </div> <div><br></div> <div><img src="/Issues/2020/May/PublishingImages/RandyBury.jpg" alt="Randy Bury" class="ms-rtePosition-1" style="margin:5px 15px;" />“This is the time for as much open transparent communication that we can have,” says Randy Bury, Good Samaritan president. “America’s history is all about handling challenges and different sorts of emergencies and disasters, so we are handling this to the best of our ability.”</div> <div><br></div> <div>The incident command center is located at the organization’s headquarters, and participants include each of the organization’s regional vice presidents as well as other key support staff like nursing and quality consultants. The calls are held at the beginning and ending of each day.</div> <h2 class="ms-rteElement-H2">About Access</h2> <div>Daily calls are especially important not only to receive federal updates but also to discuss logistical issues like resident medications or supplies such as hand sanitizers. For Good Samaritan, being a part of a health system has helped facilitate access. </div> <div><br></div> <div>“It works very well for us that we are part of a large acute care health system—Sanford Health—because once a day we also have phone calls, and we are able to express news that we have relative to supplies and equipment,” says Bury. “Also, if we have clinical questions, we can make one phone call and speak directly to a medical clinical professional.”</div> <div><br></div> <div>In mid March, Good Samaritan had no coronavirus cases, but it had begun preparing for the event that someone would become infected, Bury says.</div> <div><br></div> <div>“Right now we’re doing everything we can to hold the line but also knowing that if and when that is reached we also are spending just as much time on what we are going to do to support a local facility that ends up having a case,” says Bury. “We are reviewing those communication plans and what other infection control processes we will use. Unfortunately, I think it’s more likely to be a case of when not if.”</div> <h2 class="ms-rteElement-H2">No One Left Out</h2> <div>Good Samaritan also hosts weekly town hall meetings from its incident command center. The town hall meetings are designed for all facilities to participate. </div> <div><br></div> <div>“It’s literally hundreds of individuals on that call—all sites can participate, so an administrator at a facility somewhere in West Virginia will be on that call,” says Bury. “Our chief medical officer and our head of quality were on the call last week to provide updates and answer questions.” </div> <div><br></div> <div>While Good Samaritan commonly held town hall meetings once a month, it is now holding them once a week to help everyone stay connected on the latest updates with COVID-19. </div> <div><br></div> <div>“I think there is the feeling that we’re all in this together, and that no one is alone,” says Bury. “Even if you’re in a small 30-bed facility in rural America, we want folks to know they are not alone, and they have a linkage back to the much larger organization that has people and resources. It is also about letting our leaders know that they have a voice, and if they have a question, we will get them an answer.”</div> <h2 class="ms-rteElement-H2">Town Hall Topics</h2> <div>Supply chain issues are high on the list of topics discussed at the town hall meetings. “Everyone has the same concern on PPE, and we are monitoring our supplies very carefully, and in return we get our policies, our plans, and our communication just that much more well-oiled on these issues,” says Bury. </div> <div><br></div> <div>Staffing concerns is a close second as a popular topic. This comes up in questions like what will the company do if staff get ill?</div> <div><br></div> <div>“We are working with temporary agencies to line up the possibilities of pulling the trigger on utilizing those services, and we’re also watching optimistically some other work that’s being done with medical licensure and allowing people to cross state lines without delay—without having to go through being relicensed within a given state,” says Bury.</div> <div><br></div> <div>Ahead of the massive virus outbreak, in early January Good Samaritan and Sanford joined forces to offer health services spanning the continuum of life, including clinics, hospitals, health insurance, and senior care services.</div> <div><br></div> <div>“As a company we have 50,000 employees, and we’ve got somewhere over 8,000 nurses in the system,” he says. “Those nurses will respond and will help us out, but it doesn’t do us any good if a given state says we cannot send them out because we have to license them and do the background check, and that’s going to take a month. A month in the current crisis is like a year.”</div> <div><br></div> <div>In February, Bury and Meade participated in a White House meeting with other providers, Vice President Mike Pence, AHCA lobbyists, and CMS Administrator Seema Verma to discuss COVID-19 and issues for caring for elderly and frail residents, including medical licensure. </div> <div><br></div> <div>As an example of how current medical licensure requirements result in delays for care, Bury highlights Good Samaritan’s experience with Hurricane Dorian. </div> <div><br></div> <div>“Fortunately for everyone, that hurricane took a right-hand turn, and it wasn’t as devastating for Florida as we thought it would be. But we were having to spend an awful lot of time on the phone working with the Florida Department of Health trying to work with them on the medical licensure issue,” says Bury. “There are a lot of other issues that we need to be dealing with during an emergency.”</div> <h2 class="ms-rteElement-H2"><br></h2> <h2 class="ms-rteElement-H2">Concern for Each Other</h2> <div>Another issue that comes up in town hall meetings is the genuine concern for residents from staff, the majority of whom see residents as family, says Bury. “There is a lot of responsibility, a lot of stress involved in that, and from everything that I can see I just can’t say enough about the response from staff.” </div> <div><br></div> <div>Several staff have been working multiple days in a row, which is not uncommon during times of disaster, but the nature of COVID-19 is much different.</div> <div><br></div> <div>“Hurricanes are more of a sprint in terms of an episodic event,” says Bury. “It’s traumatic and it’s terrible, but the sun comes out within a few days. On this, it’s a marathon, and so we’re going to have to learn how to pace ourselves and how to divide and conquer this from a leadership perspective, because it’s unrealistic to think that we can have people working 12 hours a day for the next month after month.”</div> <h2 class="ms-rteElement-H2">On the Ground</h2> <div>When Jessica Toth, administrator at Good Samaritan Society–Florida Lutheran in DeLand, Fla., hears the updates from the weekly town hall meetings, she shares them with her team in daily meetings.</div> <div><br></div> <div>“Our whole team is focused on resident safety,” she says. “In our morning meetings we focus on the residents, making sure that none of them are sick. We go through their symptoms, making sure that we have everything up to date, and we follow up on any issues identified before. We also focus on employee screening. Every employee is being screened before they enter the building right now.”</div> <div><br></div> <div>Toth and her staff participate in the calls from the national campus as well as daily calls with the regional team. “That’s about an hour a day, and then we also have a weekly call as a whole campus that we participate in to make sure that we were updated,” she says. “As updates come through the day, I share them with my team via our morning and afternoon meetings.”</div> <div><br></div> <div>To help keep track of it all for staff, Toth is preparing a resource book onsite. “It’s going to be a huge binder that has all of our resources that have been provided to us from the national campus,” says Toth. The binder includes everything from recently asked questions to visitor guidelines, to a screening information checklist, to emergency numbers. </div> <div><br></div> <div>“That’s also been a huge priority, making sure that all the staff are educated and have one place they can go to get this information,” she says.</div> <div><br></div> <div>Updates are also shared through email. Through the corporate office, Toth sends out information to all employees via a newsletter called Facts Over Fear, which includes daily updates. These are also printed and placed in the binder.</div> <h2 class="ms-rteElement-H2">Drawing on Experience</h2> <div>Like other providers, Toth reflects on her experience with disasters to help make sense of COVID-19. The help received from inside the company with the resources of Sanford Health made a difference. “Having Sanford around as part of our team was a huge help to us because they were available and set up a command center at the corporate office,” she says. </div> <div><br></div> <div>“They were available to anything that we needed here in Florida 24/7; we just had to send them a text or an email,” she says. </div> <div><br></div> <div>While Hurricane Dorian helped Toth and her staff prepare, she says, there are differences. “With a hurricane situation you kind of have an idea when it’s supposed to hit and a time frame of how long you’re going to be in lockdown mode, but this is a little bit different,” she says. </div> <div><br></div> <div>“I feel like what my team went through with Hurricane Dorian is helping us, and our teamwork is stronger because of that and because we have the dedicated support 24/7,” says Toth. </div> <div><br></div> <div>At the time of her interview with Provider, Toth and her team had no identified cases of COVID-19 but had come up with a system for it if they did. “If people start to get sick or if we have a diagnosis of COVID-19 in our building, then we have designated people to help with that as Team A and created a Team B to help people who are not sick. That way we are not cross-contaminating,” she says.</div> <h2 class="ms-rteElement-H2">Keeping Residents Happy, Secure</h2> <div>Toth says residents are very understanding about new measures in place. “It’s no doubt a scary time for them, but I think they understand that everything has been put in place to help keep them healthy and safe,” she says. Staff, she says, are also doing well with the guidance and handwashing, screening, and other safety precautions. </div> <div><br></div> <div>“We’ve been still doing different fun things to keep the environment as happy as possible during this time, so we’ve had different treats in the break room, and we’re doing different things individually to try to make the days as positive as possible,” says Toth. </div> <div><br></div> <div>Keeping the connections going with families and the outside world has played a big part in helping residents and staff. Families are using Good Samaritan’s Send A Note feature via its website where anyone can write a note to a resident and attach a picture. “Monday morning, we received notes to the residents, and it is fun to share them,” says Toth. “It’s something that just brightens their day knowing that their loved ones have sent them a message.”</div> <div><br></div> <div>FaceTime meetings are popular during the week. Toth’s staff sent out letters to families inviting them to FaceTime meetings with the residents. Some family members are also coming up to residents’ outside windows to visit.</div> <h2 class="ms-rteElement-H2">Leadership Lessons </h2> <div>While Bury points out the benefit of working in a larger company like Good Samaritan and Sanford Health from a resources perspective, he also sees his organization’s experience with COVID-19 as a lesson. </div> <div><br></div> <div>“This is a leadership moment for all of us,” he says. “We should all realize that this is what we get paid for. It’s easy to continue to be a leader in the good times. But in hard times like this, now is the time for all of us to step up and support the staff and the residents and each other, and we’ve got some great things to share.” </div> <div><br></div> <div>Bury points out photos of family members in front of a facility holding up signs supporting the staff and thanking them. “Those kinds of things are what we like to be able to share as well because it kind of tells people, ‘Hey we know you’re working hard, we know there’s nothing fair about any of this, and people recognize and appreciate and thank you for what you’re doing,” he says.</div> <div><br></div> <div>“I think you have to as a leader fight against that current constantly and keep enforcing the fact that we are going to get through this. This is a marathon, but it will come to an end. We’ve encountered a lot of things over the years in this country, and this too shall pass—this is the message that I think that we need to constantly reinforce.”</div> <div><br></div> <div>Advice to other providers is all about support. “Be there to support the staff, and you can’t communicate too much,” says Bury. “You have to stay in contact. This is one of those times where my staff managers and administrators want to know that someone has their back, and you’ve got to have their back.”</div> <h2 class="ms-rteElement-H2">Consistent Communication </h2> <div>Keeping families connected goes hand in hand with the restrictions, and Meade’s staff were encouraged to get creative with communication. Residents use cordless phones throughout the facility, and staff volunteer their cell phones to help residents do FaceTime calls with family and friends. The facility has also started up its own Facebook page, posting updates and photos.</div> <div><br></div> <div> “We’re just trying to keep some form of normalcy through connections so that residents are hearing from people routinely.”</div> <div><br></div> <div>While most families have expressed concern that residents may feel forgotten, Meade says residents have been very positive and supportive in their outlook. </div> <div><br></div> <div>“They look at me and say, ‘Debbie, I know you are keeping me safe.’ That means everything because it shows they understand what we’re doing is not being done in any punitive way, it’s in an absolutely protected way.” </div> <div><br></div> <div>Read more: <a href="/archives/2020_Archives/Pages/0520/Stories-That-Inspire.aspx" target="_blank">Stories That Inspire </a><br></div>

Since first being reported as a significant health problem in late 2019 in Wuhan, China, COVID-19 has since spread in every direction, leading the World Health Organization to officially label the incurable virus a pandemic in March 2020.

2020-05-01T04:00:00Z

Caregiving;Management;Clinical;Quality

Alzheimer’s Foundation Offers Advice on Staying in Touch with families	https://www.providermagazine.com/Articles/Pages/Alzheimer’s-Foundation-Offers-Advice-on-Staying-in-Touch-with-families.aspx	Alzheimer’s Foundation Offers Advice on Staying in Touch with families	<p>Amid the coronavirus (COVID-19) pandemic and the national closing of long term care facilities to outside visitors, the Alzheimer’s Foundation of America has some tips on how families can still stay connected with a loved one in a care setting.<br>■ Speak to people in the care setting. Keep in touch with the care setting’s staff to get regular updates on loved ones, and make sure they are safe. <br>■ Utilize technology to stay connected. Many care settings are helping families stay connected through video chat, such as FaceTime, Skype, or Zoom. Ask staff in the care setting if they offer this type of service. Phone calls, emails, and letters are also good ways to keep in touch and stay connected.<br>■ Have a dialogue through photographs. Some care settings are working with families to regularly send pictures of their residents to their loved ones, and also encouraging families to send photos back for the residents to see. In some cases, they’ll encourage “themed” photos (for example, wearing a funny hat) to keep things fun and engaging.<br>■ Send care packages. Familiarity often helps reduce stress and improve mood, so sending favorite snacks, trinkets, lotions, or activities to the person can be helpful. Check with the care setting before sending to see if there are any items they do not allow for health reasons.<br>■ Don’t panic. According to officials from the Centers for Disease Control and Prevention moving an older adult from a long term care center and exposing them to more people and places is risky and could have long-lasting impacts.<br></p>	Amid the coronavirus (COVID-19) pandemic and the national closing of long term care facilities to outside visitors, the Alzheimer’s Foundation of America has some tips on how families can still stay connected with a loved one in a care setting.	2020-05-01T04:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/0520_News2.jpg" style="BORDER:0px solid;" />	COVID-19;Dementia
CMS Proposes 2.3 Percent Market Basket Hike in 2021 SNF PPS	https://www.providermagazine.com/Articles/Pages/CMS-Proposes-2.3-Percent-Market-Basket-Hike-in-2021-SNF-PPS.aspx	CMS Proposes 2.3 Percent Market Basket Hike in 2021 SNF PPS	<p>The Centers for Medicare & Medicaid Services (CMS) has issued its annual Skilled Nursing Facility Prospective Payment System (SNF PPS) Fiscal Year (FY) 2021 proposed rule, calling for a 2.3 percent market basket increase, a proposal that drew praise from long term and post-acute care advocates. <br></p><p>CMS estimates that the net market basket update would increase Medicare SNF payments by approximately $784 million in FY 2021. <br></p><p>Mark Parkinson, president and chief executive officer of the American Health Care Association (AHCA), said, “We applaud CMS for issuing this SNF PPS proposed rule. Skilled nursing facilities across the country are working around the clock to protect the people who are most vulnerable to COVID-19. That work makes this 2.3 percent market basket increase more important than ever.”<br></p><p>He added that “our long term care staff are heroically going above and beyond to care for millions of residents amid the COVID-19 pandemic.”<br></p><p>The proposed rule, combined with the Patient-Driven Payment Model (PDPM) implemented last year, “helps us continue our work to provide the highest quality care possible,” Parkinson said. “With an all-in margin of -0.3 percent, there are still real challenges for skilled nursing providers. However, this increase gets us headed in the right direction.”<br></p><p>On PDPM monitoring, AHCA said in the proposal CMS indicates the agency will continue to monitor the impact of PDPM implementation on patient outcomes and program outlays. CMS notes that it would be premature to release any information related to these issues based on the amount of data currently available. <br></p><p>Also of note, as part of updating Core-Based Statistical Areas (CBSAs), CMS is capping decreases in wage indices at 5 percent to prevent precipitous drops.<br></p><p>In its summary, CMS said in the FY 2021 SNF PPS proposed rule the agency is proposing to align the SNF Value-Based Purchasing (VBP) Program regulation text with previously finalized policies, to apply the 30-day Phase One Review and Correction deadline to the baseline period quality measure quarterly report, and to establish performance periods and performance standards for upcoming program years.<br></p><p>CMS said it is not proposing to make any changes to the measures, SNF VBP scoring policies, or payment policies.<br>Highlights include:<br>■ The proposed rule provides for a net market basket increase for SNFs of 2.3 percent beginning Oct. 1, 2021. Note: This may change slightly in the final rule based on updated data since proposed rule was developed.<br>■ The 2.3 percent market basket update reflects an unadjusted market basket increase of 2.7 percent reduced by 0.4 percentage points, in accordance with the multifactor productivity adjustment required by Section 3401(b) of the Affordable Care Act. No forecast error was incurred. <br>■ The unadjusted market basket percentage of 2.7 percent for FY 2018 for the SNF PPS is based on the IHS Global Insight (IGI) first quarter 2020 forecast with historical data through fourth quarter 2019. This figure could change when CMS issues the final rule in July 2020 using more recent IGI data. <br>■ CMS estimates that the net market basket update would increase Medicare SNF payments by approximately $784 million in FY 2021. <br>■ A forecast error correction was not needed. Since the difference between the estimated and actual amount of change in the market basket index was below the 0.5 percentage point threshold in FY 2015, the payment rates for FY 2019 are not impacted by the current IGI data. <br>■ In regard to the SNF PPS Wage Index, as revised Office of Management and Budget delineations are adopted, CMS proposes to use a 5 percent cap on significant wage index decreases in CBSAs with notable declines. CMS proposes to use a budget neutrality factor to account for the 5 percent cap on significant decreases and ensure the overall transition is budget neutral. <br>■ Regarding PDPM monitoring, CMS indicates that they “continue to monitor the impact of PDPM implementation on patient outcomes and program outlays, though we believe it would be premature to release any information related to these issues based on the amount of data currently available.”<br>■ In addition, the agency says that they “continue to monitor the impact of PDPM implementation as it relates to our intention to ensure that PDPM is implemented in a budget-neutral manner,” and that, “in future rulemaking, we may reconsider the adjustments made in the FY 2020 SNF PPS final rule to the case-mix weights used under PDPM to ensure budget neutrality and recalibrate these adjustments as appropriate, as we did after the implementation of RUG-IV in FY 2011.” <br>■ With regard to PDPM ICD-10 Mappings, CMS proposes several substantive changes to the ICD-10-CM code mappings to reflect the primary reason for SNF stays that require public comment. The changes were based on recommendations from stakeholders and address codes that could be eligible for reassignment into a surgical category, based on Minimum Data Set Section J2100-J5000 major procedure items, codes that were incorrectly identified as “return to provider,” as well as other existing codes that were listed in an inappropriate default clinical category. <br></p>	CMS estimates that the net market basket update would increase Medicare SNF payments by approximately $784 million in FY 2021.	2020-05-01T04:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/0520_news3.jpg" style="BORDER:0px solid;" />	CMS
Experts Make Changes to How Muscle Loss Is Diagnosed and Cared For	https://www.providermagazine.com/Articles/Pages/Experts-Make-Changes-to-How-Muscle-Loss-Is-Diagnosed-and-Cared-For.aspx	Experts Make Changes to How Muscle Loss Is Diagnosed and Cared For	<p>A new version of how to treat and diagnose age-related muscle mass, or sarcopenia, delves into the differences between examining at-risk populations in the community and facility settings.<br></p><p>The findings by the Asian Consensus Update on Sarcopenia were published in a recent issue of <em>JAMDA</em> and build on previous versions offering clinical recommendations on the condition.<br></p><p>In this latest version, researchers observed that the newest update includes the same definition of sarcopenia detailed in the 2014 consensus: an age-related loss of muscle mass, plus low muscle strength, and/or low physical performance. <br></p><p>“However, the latest consensus has revised the diagnostic algorithm, protocols, and some criteria. It also proposes separate algorithms for community versus hospital settings to facilitate earlier identification of those individuals at risk for sarcopenia,” the authors said. Although skeletal muscle strength and mass are both considered fundamental to a definitive clinical diagnosis of sarcopenia, researchers observed that the 2019 consensus “introduces ‘possible sarcopenia,’ defined by either low muscle strength or low physical performance only, specifically for use in primary health care or community-based health promotion, to enable earlier lifestyle interventions.”<br></p><p>They further observed that while defining sarcopenia by Body Mass Index-adjusted muscle mass instead of height-adjusted muscle mass may predict adverse outcomes better, “more evidence is needed before changing current recommendations.”<br></p><p>Lifestyle interventions, the authors noted, prevail as treatment mainstays. However, they said, “Further research is needed to investigate potential long-term benefits of lifestyle interventions, nutritional supplements, or pharmacotherapy for sarcopenia.”<br></p><p>For definition, low muscle strength is defined as handgrip strength less than 28 kilograms (around 60 pounds) for men and less than 18 kilograms (40 pounds) for women. <br></p>	A new version of how to treat and diagnose age-related muscle mass, or sarcopenia, delves into the differences between examining at-risk populations in the community and facility settings.	2020-05-01T04:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/therapy_1.jpg" style="BORDER:0px solid;" />	Caregiving
HHS Releases First $30 Billion of Stimulus Funds, SNFs Included	https://www.providermagazine.com/Articles/Pages/HHS-Releases-First-$30-Billion-of-Stimulus-Funds,-SNFs-Included.aspx	HHS Releases First $30 Billion of Stimulus Funds, SNFs Included	<p>The Department of Health and Human Services (HHS) has announced the distribution of the first $30 billion of the $100 billion stimulus fund, which skilled nursing facilities (SNFs) are in line to receive, according to a statement by Mark Parkinson, president and chief executive officer of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).<br></p><p>He noted that reporting that this stimulus fund was only for hospitals was incorrect, as SNFs are included.<br></p><p>Other highlights are the following: <br>■ All Medicare providers will receive payments based on their 2019 Part A and Part B billings.<br>■ AHCA/NCAL will provide a more detailed analysis in later days, but a quick back of the envelope analysis indicates that providers will receive roughly 6.2 percent of their 2019 billings. <br>■ HHS intends to get the money to providers directly. It may have hit some provider accounts as early as April 10. <br>■ This is a grant. It is not a loan. <br></p><p>Parkinson said this stimulus funding program is in addition to the Accelerated Payment Program. Providers can participate in both. <br></p><p>More details on the stimulus funding include that HHS is partnering with UnitedHealth Group to deliver the initial $30 billion distribution to Medicare providers. Providers will be paid electronically where possible. <br></p><p>AHCA/NCAL said providers that normally receive a paper check for reimbursement from the Centers for Medicare & Medicaid Services (CMS) will receive a paper check in the mail for this payment as well.<br></p><p>All facilities and providers that received Medicare fee-for-service (FFS) reimbursement in 2019 are eligible for this initial rapid distribution. <br></p><p>Payments to practices that are part of larger medical groups will be sent to the group’s central billing office. All relief payments are made to the billing organization according to its Taxpayer Identification Number.<br></p><p>AHCA/NCAL said as a condition to receiving these funds, providers must agree not to seek collection of out-of-pocket payments from a COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.<br></p><p>This dispersal of funds is intended to provide relief to both providers in areas heavily impacted by the COVID-19 pandemic and those providers that are struggling to keep their doors open due to healthy patients delaying care and cancelled elective services. This provision will aid providers with declining occupancy rates.<br></p><p>Providers will be distributed a portion of the initial $30 billion based on their share of total Medicare FFS reimbursement in 2019. This means that CMS, as with calculating the Accelerated and Advance Payments, has used net reimbursement based on claims to calculate the award amounts.<br></p><p>Total FFS payments were approximately $484 billion in 2019. A provider can estimate its payment by dividing the 2019 Medicare FFS (not including Medicare Advantage) payments it received by $484,000,000,000, and multiplying that ratio by $30,000,000,000.<br></p><p>Providers can obtain their 2019 Medicare FFS billings from their organization’s revenue management system. Providers should work with their financial management, revenue cycle divisions, or third-party billing contractors to arrive at their own estimates.<br></p><p>AHCA/NCAL provided this calculation example. A provider billed Medicare FFS $121 million in 2019. To determine how much it would receive, use this equation: $121,000,000 / $484,000,000,000 x $30,000,000,000 = $7,500,000 <br>Also, in coming weeks, funds will be released for providers in areas particularly impacted by the COVID-19 outbreak, rural providers, low-volume Medicare providers of services, providers who predominantly serve the Medicaid population, and providers requesting reimbursement for the treatment of uninsured Americans.<br></p><p>The terms and conditions are within 30 days of receiving the payment, and providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. <br></p><p>The portal for signing the attestation was to open the week of April 13, 2020.<br></p><p>Visit HHS’ FAQ for additional information on eligibility and process.</p>	HHS has announced the distribution of the first $30 billion of the $100 billion stimulus fund, which skilled nursing facilities are in line to receive,	2020-05-01T04:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/0520_news4.jpg" style="BORDER:0px solid;" />	Capitol Hill
Providers Count Decision on Observation Stay Status as Important Win	https://www.providermagazine.com/Articles/Pages/Providers-Count-Decision-on-Observation-Stay-Status-as-Important-Win.aspx	Providers Count Decision on Observation Stay Status as Important Win	<p>Long term and post-acute care (LT/PAC) providers are applauding a decision issued by Judge Michael Shea of the U.S. District Court in Hartford, Conn., that said certain Medicare beneficiaries classified as being in observation status at hospitals and not admitted as inpatients can appeal this designation to the Medicare program.<br></p><p>The ruling in the Alexander v. Azar case is significant to LT/PAC providers and their residents nationwide, advocates for the profession say.<br></p><p>“This is an important win and a positive step for our residents,” says Dana Ritchie, senior director of not for profit and constituent services, American Health Care Association/National Center for Assisted Living (AHCA/NCAL). “The three-day stay rule causes many outpatients who need follow-up care to be on their own or in debt with thousands in out-of-pocket costs because they do not qualify for Medicare coverage in a nursing center.”<br></p><p>She says for years AHCA/NCAL has advocated to eliminate what is a “confusing policy barrier by recognizing observation stays as qualifying stays for the purposes of the three-day stay requirement or eliminating the three-day requirement altogether.”<br></p><p>Ritchie says, “We appreciate the court’s decision in allowing for these appeals to help our residents receive the quality care they deserve.”<br></p><p>The importance of an individual’s categorization as inpatient or in observation status lies in the fact that Medicare only pays for subsequent care in a skilled nursing facility for patients who were hospitalized as inpatients for three or more consecutive days.<br></p><p>Those in observation status are labeled as outpatients and cannot receive coverage for care in a skilled nursing center.<br></p><p>Judith Stein, attorney and executive director for the Center for Medicare Advocacy, which represented the plaintiffs in the case, said, “The court heard the voices of our clients, who represent the thousands of Medicare beneficiaries faced with the baffling observation issue—when they are already dealing with a hospitalization for significant illnesses and injuries.<br></p><p>“Fairness and due process require that they have an opportunity to appeal their hospital observation status to Medicare, just as they can for most other issues affecting their Medicare coverage,” she said.<br></p><p>In his ruling on what was a class-action suit lasting nearly a decade in litigation, Shea said he found some class members, specifically, “those who were initially admitted as inpatients by a physician but whose status during their stay was changed to observation, have demonstrated that the Secretary [of Health and Human Services] is violating their due process rights.”<br></p><p>Shea said the trial evidence showed that such changes are invariably caused by utilization review staff applying mandatory, nationwide standards set by the Centers for Medicare & Medicaid Services in response to significant pressure from the Secretary.<br></p><p>“For class members whose inpatient status was changed to observation, then, there is enough involvement by the government to find that the deprivation of their property interest in Part A coverage was fairly attributable to the Secretary and thus a product of ‘state action,’ a necessary element of a due process claim,” Shea said.<br></p><p>“Just as the Secretary cannot deprive these beneficiaries of Part A coverage directly without affording them the procedural protections to which the Constitution entitles them, the Secretary cannot do so indirectly through a hospital’s utilization review process.”<br></p><p>However, the judge said other members of the class—those whose physicians initially placed them on observation status and who were never admitted as inpatients—have failed to prove their due process claims, because the physicians’ decisions generally did not constitute state action.<br></p><p>“These class members have also failed to prove a separate property interest in inpatient admission, because a physician’s admission decision is not governed by the sort of mandatory standards that can create a property interest under the law,” Shea said.<br></p><p>To this end, he ordered the Secretary to establish a procedure that will allow the following modified class of Medicare beneficiaries to challenge decisions by hospitals to place them on “observation” status:<br>“All Medicare beneficiaries who, on or after Jan. 1, 2009: (1) have been or will have been formally admitted as a hospital inpatient; (2) have been or will have been subsequently reclassified as an outpatient receiving “observation services;” (3) have received or will have received an initial determination or Medicare Outpatient Observation Notice (MOON) indicating that the observation services are not covered under Medicare Part A; and (4) either (a) were not enrolled in Part B coverage at the time of their hospitalization or (b) stayed at the hospital for three or more consecutive days but were designated as inpatients for fewer than three days, unless more than 30 days had passed after the hospital stay without the beneficiary’s having been admitted to a skilled nursing facility. <br>“Medicare beneficiaries who meet the requirements of the foregoing sentence but who pursued an administrative appeal and received a final decision of the Secretary before Sept. 4, 2011, are excluded from this definition.”<br></p>	LT/PAC providers are applauding a decision that said certain Medicare beneficiaries classified as being in observation status at hospitals and not admitted as inpatients can appeal this designation to the Medicare program.	2020-05-01T04:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/0520_News1.jpg" style="BORDER:0px solid;" />	Observation Stays

Chief Executive Officer	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=20	Chief Executive Officer	<img alt="Linda MowBray" src="/Issues/2020/May/PublishingImages/LindaMowBray.jpg?RenditionID=24" style="BORDER:0px solid;" />	Linda MowBray	Kansas Health Care Association
On-Site Hospitalist	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=21	On-Site Hospitalist	<img alt="Alan Thompson, MD" src="/PublishingImages/People%20on%20the%20Move/AlanThompson.jpg" style="BORDER:0px solid;" />	Alan Thompson, MD	Rolling Green Village
Executive Vice President of Clinical Services	https://www.providermagazine.com/Lists/People On The Move/DispForm.aspx?ID=22	Executive Vice President of Clinical Services	<img alt="Brian Grahame" src="/PublishingImages/People%20on%20the%20Move/BrianGrahame.jpg" style="BORDER:0px solid;" />	Brian Grahame	Retirement Unlimited

May 2020

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