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AHCA, NCAL Applaud CDC, FDA for Approving Booster Shots for Long Term Care Residents, Workers<p>The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) released the following statement in response to the recommendations by the Centers for Disease Control and Prevention (CDC) as well as the Food and Drug Administration (FDA) to approve booster shots of the Moderna and Janssen (Johnson and Johnson) COVID-19 vaccines for certain individuals, including residents and health care workers in long term care.</p><p>The following statement is attributable to David Gifford, MD, chief medical officer of AHCA/NCAL&#58;</p><p>“Once again, we appreciate the FDA and CDC for thoroughly examining the data and following the science to help protect Americans, including our nation’s most vulnerable, from COVID-19. All long term care residents and staff members will now be eligible to receive a booster shot thanks to these expanded recommendations.</p><p>“Additionally, the ability to mix-and-match vaccines for the booster dose will make it easier for long term care facilities to swiftly access these vaccines for their residents and staff. </p><p>“The rollout of the Pfizer booster shot has gone incredibly well in long term care, and we are confident that adding Moderna and Johnson and Johnson into the mix will catapult our efforts. We appreciate the partnership of federal and state governments, as well as long term care pharmacies and other vaccine providers, to make these vaccination efforts in nursing homes and assisted living communities efficient and successful.”<br></p>2021-10-22T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0220_News1.jpg" style="BORDER&#58;0px solid;" />COVID-19Joanne EricksonApproving additional vaccines for the booster dose will make it easier for facilities to gain access to shots for their residents and staff.
AHCA, NCAL Send Letter to Federal Trade Commission on Staff Agency Price Gouging<p>​The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) sent a letter this week to Federal Trade Commission (FTC) Chairwoman Lina Khan, requesting assistance with an anticompetitive practice with direct care staffing agencies.<br><br>In the letter, AHCA/NCAL President and Chief Executive Officer Mark Parkinson describes how the COVID-19 pandemic has spurred an unprecedented workforce crisis within the long term care sector.<br></p><p>According to the Bureau of Labor Statistics, nursing homes and residential-care facilities employed 3 million people in July, down 380,000 workers from February 2020. Providers are doing all that they can to hire and recruit workers, including sign-on bonuses, wage increases, and referral bonuses.<br><br>Amid these circumstances, direct care staffing agencies are charging exorbitant prices to long term care facilities that need workers. AHCA/NCAL state affiliates are undertaking legislative efforts to prevent these agencies from charging more than double and—in some cases—as much as quadruple the amount operators are currently paying their staff.<br></p><p>AHCA/NCAL requests that the FTC use its authority to investigate this price gouging and take appropriate action to protect long term care facilities.<br><br>Read the full letter <a href="/Breaking-News/Documents/AHCA_NCAL%20FTC%20Staff%20Agency%20Letter%2010.19.21.pdf">here</a>.<br></p>2021-10-21T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/letter_writing.jpg" style="BORDER&#58;0px solid;" />WorkforceJoanne EricksonAgencies taking advantage of worker shortages by greatly overcharging facilities that need them.
Staffing Challenges in Long Term Care Facilities Continue to Threaten Resident Access to Care <p>The COVID-19 pandemic has put a tremendous strain on nursing homes and assisted living communities across the country, but one area that continues to worsen among facilities is the workforce crisis. Long term care facilities are experiencing growing staff vacancies as burned-out caregivers exit the profession.</p><p>A recent American Health Care Association and National Center for Assisted Living (AHCA/NCAL) <a href="https&#58;//">survey </a>found that 86 percent of nursing homes and 77 percent of assisted living providers say their workforce situation has gotten worse in just a few months.</p><p>Providers want to offer higher wages and better benefits to attract and retain employees but lack the necessary funds to do so. For years nursing homes have faced low Medicaid reimbursement rates that do not adequately cover the cost of care. These low rates, coupled with additional expenses from the pandemic, have left many facilities in financial turmoil. And now as staff challenges grow, providers are left without the means to hire new workers or keep their current ones.</p><p>Washington Newsday recently <a href="https&#58;//">reported </a>the dire labor shortages in long term care. According to data from the Bureau of Labor, nursing homes and residential care facilities have lost <a href="https&#58;//;output_view=data&amp;include_graphs=true">more than 425,000 employees </a>during the course of the pandemic.</p><p>Fewer caregivers are forcing many facilities to have to turn away new residents. The AHCA/NCAL survey also found that 58 percent of nursing homes have had to limit new admissions because of a lack of employees. A recent story in <a href="https&#58;//">MarketWatch </a>highlighted the significant drop in nursing home occupancy during the pandemic. In just the span of a year, occupancy rates fell from 85 percent to 68 percent. Now, nursing homes are struggling to recover due, in part, to staffing shortages, as occupancy rates have only increased to 72 percent.</p><p>These alarming drops in employment signify the urgent need for Congress to step in. Lawmakers can address chronic staffing challenges through the reconciliation package currently in discussion. In addition, the <a href="https&#58;//">Care for Our Seniors Act,</a> a comprehensive reform proposal developed by AHCA and LeadingAge, offers solutions such as assistance programs for caregivers through tax credits, loan forgiveness, and child care, as well as incentives for higher learning institutions to train the next generation of health care workers. </p><p>Long term care residents require around-the-clock clinical assistance. When they cannot access the nursing home or assisted living community they want due to staffing shortages, they are left scrambling to look for alternative options, often in facilities farther away from their families and community of choice. Lawmakers must recognize the severity of the workforce shortage and work together to invest in these necessary caregivers so no resident is left without the care they need. <br></p>2021-10-18T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0120_News1.jpg" style="BORDER&#58;0px solid;" />WorkforceJoanne EricksonGrowing employee vacancies exacerbate workforce crisis as staff exit the profession.
AHCA, NCAL Elect Boards and Directors at Annual Convention<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 2021/2022 term. Phil Fogg of Oregon was elected AHCA Chair, and Gerald Hamilton of New Mexico was elected NCAL Chair. </p><p>“We are thrilled to have Phil and Gerald as the chairs of our Boards,” said AHCA/NCAL President and Chief Executive Officer (CEO) Mark Parkinson. “They are incredible, influential leaders dedicated to seeing the industry through this challenging time, so we come out stronger, as well as providing the highest quality of care to our residents. I am confident they will do an amazing job leading our sector this next year.”</p><p>Fogg is the president and CEO of Marquis Companies in Milwaukie, Ore. As the fourth generation of a family of long term care providers, it was inevitable that Fogg would devote his life to serving seniors. His great-grandmother was one of Oregon’s pioneers in the profession, and by the age of 13, he was already working in his father’s facilities—doing laundry, washing dishes, making beds, or whatever else was needed. He previously served as Vice Chair on AHCA’s Board of Governors. </p><p>The remaining members of AHCA’s 2021-2022 board include&#58;</p><p>•&#160;Phil Scalo of Bartley Healthcare (N.J.), Vice Chair<br>•&#160;Chris Wright of iCare Health Network (Conn.), Secretary/Treasurer <br>•&#160;Debbie Meade of Health Management (Ga.), Immediate Past Chair<br>•&#160;Derek Prince of HMG Healthcare (Texas), At-large Representative <br>•&#160;Sarah Schumann of Brookside Inn (Colo.), At-large Representative <br>•&#160;Tina Sandri of Forest Hills (D.C.), At-large Representative<br>•&#160;Reginald Hartsfield of Advantage Living Centers (Mich.), At-large Representative<br>•&#160;Julianne Williams of Elevate Health Care (Calif.), At-large Representative <br>•&#160;Alex Terentev of Lilac Health Group (Fla.), At-large Representative<br>•&#160;Steve Flatt of National Healthcare Corp. (Tenn.), Multifacility Representative&#160; <br>•&#160;Randy Bury of The Evangelical Lutheran Good Samaritan Society (S.D.), Not-for-profit Representative<br>•&#160;Mark Traylor of Traylor Porter Healthcare (Ala.), Independent Owner Representative <br>•&#160;Ted LeNeave of Accura Healthcare (Iowa), Regional Multifacility Representative<br>•&#160;Gerald Hamilton of BeeHive Homes of Albuquerque (N.M.), NCAL Representative<br>•&#160;Jesse Samples of the Tennessee Health Care Association, ASHCAE Representative<br>•&#160;Betsy Rust of Plante Moran, Associate Business Member Representative</p><p>NCAL also elected its Board of Directors today, including Hamilton as its new chair. He is the co-owner of BeeHive Homes and has 35 years of experience in health care management as an assisted living facility owner/operator, licensed nursing home administrator, regional manager of multiple nursing homes, and consultant. After a successful career in nursing home administration in California, New Mexico, and Colorado, he started his own business to construct and operate assisted living communities.&#160; </p><p>The remaining members of NCAL’s Board of Directors include&#58;</p><p>•&#160;Mark Maxfield of The Cottages (Idaho), Vice Chair<br>•&#160;Sarah Silva of Avamere Health Services (Ore.), Secretary/Treasurer<br>•&#160;Helen Crunk of Pemberly Place (Neb.), Immediate Past Chair,<br>•&#160;John Bolduc of Odd Fellows’ and Rebekahs’ Home of Maine (Maine), At-large Representative<br>•&#160;Rod Burkett of Gardant Management Solutions (Ill.), At-large Representative<br>•&#160;Megan Campbell of IntegraCare Corp. (Pa.), At-large Representative<br>•&#160;Sue Coppola of Sunrise Senior Living (Va.), At-large Representative<br>•&#160;Ana de la Cerda of Aegis Living (Wash.), At-large Representative<br>•&#160;Todd Dockerty of Dockerty Health Care Services (Mich.), At-large Representative<br>•&#160;Darryl Fisher of Mission Senior Living (Nev.), At-large Representative<br>•&#160;Stacy Hejda of Assisted Living Partners (Iowa), At-large Representative&#160; <br>•&#160;Esmerelda Lee of Century Park Associates (Tenn.), At-large Representative<br>•&#160;Barbara Mitchell of Magnolia Manor (Ga.), At-large Representative<br>•&#160;Gail Sheridan of Lifespark, formerly Tealwood Senior Living (Minn.), At-large Representative<br>•&#160;Elizabeth Wheatley of Benchmark Senior Living (Mass.), At-large Representative<br>•&#160;Kristopher Woolley of Avista Senior Living (Ariz.), At-large Representative<br>•&#160;Phil Scalo of Bartley Healthcare (N.J.), AHCA Vice Chair<br>•&#160;Phil Fogg of Marquis Companies (Ore.), AHCA Chair<br>•&#160;Peter Corless of OnShift, Associate Business Member Representative <br>•&#160;Doug Farmer of Colorado Health Care Association, State Affiliate Representative<br>•&#160;David Voepel of Arizona Health Care Association, ASHCAE Vice President </p><p>“We are incredibly fortunate for this year’s Board members, and their time and contribution to assisted living,” said NCAL Executive Director LaShuan Bethea. “Now more than ever, we need their leadership to guide us during these challenging years ahead, and looking at this group of individuals I am truly excited about all they will accomplish for our profession.”</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 the NCAL State Leaders. Both boards hold annual elections at the AHCA/NCAL Convention &amp; Expo.<br></p>2021-10-13T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/PhilFogg.jpg" style="BORDER&#58;0px solid;" />ManagementJoanne EricksonAssociations elect annual Board line-ups during final hours of AHCA/NCAL 72nd Convention & Expo.



Common PDPM Missteps and How to Avoid Them PDPM Missteps and How to Avoid Them<p><img src="/Monthly-Issue/2021/October/PublishingImages/JenniferLaBay.jpg" alt="Jennifer LaBay" class="ms-rtePosition-1" style="margin:5px;width:145px;height:186px;" />In October 2019, the Patient-Driven Payment Model (PDPM) became the new payment methodology for Medicare Part A residents in skilled nursing facilities (SNFs). Although PDPM has been in effect for two years, the public health emergency may have temporarily shifted priorities for some facilities.<br></p><p>This temporary shift, combined with PDPM’s relative newness and recent staff turnover, may have significantly affected Medicare revenue over the past 18 months.<br></p><p>Here are three common missteps that may be impacting a facility’s Medicare reimbursement.<br><br><em>1. Managing the Assessment Reference Date (ARD)</em><br>The Medicare 5-Day assessment has an ARD range of Days 1-8 of the SNF Part A-covered stay. Nurse assessment coordinators (NACs) who insist on using Day 8 as the ARD for all 5-Day assessments may not capture all the services or conditions that impact Medicare revenue.<br></p><p>Since payment is no longer based on therapy minutes, facilities may benefit from finessing their ARDs to ensure documentation is in place to capture key services and diagnoses. The ARD for the 5-Day assessment must be set on a Minimum Data Set (MDS) form or in the MDS software no later than 11:59 p.m. on Day 8 of the Medicare stay. Once that time and date passes, the ARD cannot be changed, but until that point, it can be adjusted.<br></p><p>Ideally, on Day 8, the NAC should be completing a full chart review, including preadmission records, to determine the care and services that were provided. Using the calculation worksheets in chapter 6 of the “Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User’s Manual,” the NAC can determine the optimal ARD to capture the care and services, which will result in the best PDPM case-mix groups (CMGs).<br></p><p>Choosing Day 8 as the ARD instead of Day 2 could make a difference of hundreds of dollars per day, depending on what services were delivered and diagnoses assigned during the observation period.<br></p><p>Some examples of missed opportunities related to improper ARD selection include:<br></p><ul><li>Not capturing cognitive impairment under the Speech-Language Pathology (SLP) component can occur when the Brief Interview for Mental Status (BIMS) is not conducted during the look-back period. If BIMS was completed on Day 1 of the stay and the ARD selected is Day 8, the BIMS is outside of the range for inclusion on the MDS.</li></ul><p>Per RAI manual instructions, page C-2, “Item C0100 must be coded 1, Yes, and the standard ‘no information’ code (a dash ‘-’) entered in the resident interview items. Do not complete the Staff Assessment for Mental Status items (C0700-C1000) if the resident interview should have been conducted but was not done.”<br></p><p>Preferably, the BIMS should be completed on the day of or the day before the ARD. Staff must be aware of all services that have been provided each day so that an ARD can be selected for a timely completion of the interview.<br></p><ul><li>Not capturing IV fluids or parenteral feeding from the hospital will impact the Nursing component of PDPM. Calculation for the Special Care High CMG comes from a 7-day look-back for both while a resident and while not a resident. If these services were received in the hospital, it may be beneficial to choose an earlier ARD to capture the IV or parenteral feeding.<br></li></ul><p><em>2. Assigning Primary Diagnosis Codes</em><br>Part of PDPM accuracy is ensuring the appropriate primary diagnosis is selected in section I0020B of the MDS. Some common diagnoses that have historically been used as a primary reason for admission to a SNF that, per the Centers for Medicare and Medicaid Services, will not map to a billable clinical category include weakness, failure to thrive, falls, and altered mental status. All of these calculate as return to provider (RTP) diagnoses in the PDPM ICD-10-CM mapping tool.<br></p><p>RTP diagnoses do not reflect care and services that would meet the skilled coverage criteria outlined in chapter 8 of the “Medicare Benefit Policy Manual” and will not generate a CMG. This may lead to payment at the default rate or, worse, provider liability. When this occurs, facilities need to dig deeper and query the physician or non-physician providers (NPP) about the cause of these conditions. <br></p><p>The better clinicians understand the nature of the problem, the better resident care will be, and the more accurate the payment category. It is important for the SNF team to discuss as a group before and after admission to ensure the medical record and MDS reflect the true reason for all skilled care. If there is no underlying cause found, the resident may not meet Medicare skilled coverage criteria. <br><br><em>3. Assigning Additional Diagnosis Codes</em><br>In addition to the Primary Diagnosis at I0020B, which affects the Physical Therapy (PT), Occupational Therapy (OT), and SLP components, the additional diagnoses in section I of the MDS may impact the SLP, Nursing, and Non-Therapy Ancillary (NTA) components as well. Unlike I0020B, diagnoses coded in sections I0100 – I8000 do not have to follow the clinical category map with the RTP restriction.<br></p><p>However, facilities do still need to use the ICD-10-CM map. SLP and NTA comorbidities captured in I8000 must be cross-referenced with the corresponding tabs in the ICD-10-CM mapping tool to determine if the criteria have been met for capturing the comorbidity in the PDPM CMG.<br></p><p>Another requirement for capturing the diagnosis in section I of the MDS is that the diagnosis must be documented in the medical record by the physician or NPP within 60 days of the ARD and must be active in the 7-day look-back period (excluding UTI, which must be active in the last 30 days).<br></p><p>If the medical record suggests a historical diagnosis, but there is not proper documentation from the provider during the look-back period, it is beneficial to use a later ARD to allow time for the provider to include this documentation in the medical record. <br></p><p>Some common PDPM missteps related to ICD-10-CM coding include:<br></p><ul><li>Assigning a primary diagnosis that affects only one discipline instead of the overall skilled needs of the resident. For example, PT, OT, and nursing are treating removal (explantation) of hip joint, which maps to Orthopedic Surgery, while nursing is treating complication of infected hip joint, which maps to Acute Infections. Because most of the skilled care is provided to treat the explantation of the hip, that should be captured as the primary diagnosis.</li><li>Not capturing a diagnosis such as septicemia that is active at the beginning of the Medicare stay. An earlier ARD could allow capture of an active diagnosis from the hospital.</li><li>Not querying the physician or NPP for diagnosis clarification when the diagnosis is only listed in past medical history. For example, a history of cerebrovascular accident (CVA) with no residual deficits identified may miss clinically present sequelae (neurologic deficits).</li><li>Not capturing section I diagnoses correctly. Some NTA comorbidity points are assigned by section I0100 - I7900 checkboxes and others by I8000 ICD-10-CM codes. For example, coding Diabetes Type 2, E11.9, in I8000, will not accrue NTA points. MDS item I2900 for diabetes must be checked.</li></ul><p>NACs must diligently apply all the rules of PDPM, MDS, and ICD-10-CM coding. Understanding the “RAI User’s Manual” instructions and ICD-10-CM coding guidelines is essential to PDPM accuracy and success. <br><br><em><a href="" target="_blank">Jennifer LaBay,</a> RN, RAC-MT, RAC-MTA, CRC, is curriculum development specialist for the American Association of Post-Acute Care Nursing (AAPACN). </em><br>​</p>Nurse assessment coordinators must assign each patient’s assessment reference date to capture key diagnoses that impact Medicare revenue.2021-10-01T04:00:00Z<img alt="" src="/Monthly-Issue/2021/October/PublishingImages/1021_mgmt.jpg" style="BORDER:0px solid;" />ManagementJennifer LaBay

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