| Breaking the Polypharmacy Cycle in LTC: Strategies for Clinical and Financial Success | <p>
<strong class="ms-rteForeColor-2">ADVERTORIAL</strong></p><a href="https://guardianpharmacy.com/provider-resources/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><img src="/SiteCollectionImages/logos/Guardian-Pharmacy-Services-.png" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:107px;" /></a>
<p>Polypharmacy, broadly defined as the use of multiple medications, poses a formidable challenge in long term care (LTC), with negative financial implications for communities and potentially harmful consequences for residents. As the older population in the U.S. continues to grow at an exponential rate and develops many of the medical conditions associated with aging, the reliance on multiple medications to address these issues has surged. As a result, the prevalence of polypharmacy in LTC communities has reached daunting levels. </p><p>The consequences of polypharmacy not only include an increased risk of adverse drug reactions, drug interactions, hospitalizations, and falls among residents, but it also imposes a substantial financial strain on LTC operators as residents require a greater level of care.</p><h3>Defining Polypharmacy and Its Drivers<br></h3><p>Polypharmacy is a complex topic with varying perspectives. While no standard definition exists, it commonly refers to the use of five or more medications daily. A systematic review published in the
<em>Journal of Post-Acute and Long-Term Care</em> revealed that among residents in these communities, 91 percent were taking more than five medications, while 65 percent were taking more than 10. With the Lown Institute predicting that inappropriate polypharmacy will cost the healthcare system an additional $62 billion between 2020 and 2030, it’s crucial to understand the drivers behind polypharmacy.</p><h3>Factors That Contribute to Polypharmacy</h3><p>
<strong>Prescribing cascades:</strong> These occur when a medication causes a side effect that is mistaken for a new medical condition, leading to additional prescriptions. This creates a cycle of escalating medication use.</p><p>
<strong>Clinical practice guidelines and limited deprescribing guidance:</strong> Guidelines often recommend multiple medications for residents with complex conditions, increasing the risk of polypharmacy. Meanwhile, few guidelines exist to support deprescribing—the supervised reduction or discontinuation of unnecessary or harmful medications—so residents may continue taking drugs they no longer need.</p><p>
<strong>Increased availability of condition-specific medications: </strong>The expanding number of available drugs, combined with direct-to-consumer marketing and resident requests, drives up prescribing. Use of multiple prescribers, such as specialists, and guideline recommendations for multiple medications per medical condition further compound the issue.</p><h3>The Detrimental Effects of Polypharmacy on Resident Outcomes </h3><p>Polypharmacy has serious consequences for residents, leading to a range of negative outcomes that affect their health and well-being. It increases the risk of falls, adverse drug reactions, medication interactions, and non-adherence. This results in longer hospital stays, more frequent readmissions, and even higher mortality rates. In fact, polypharmacy is responsible for nearly 30percent of all hospital admissions an</p><p>d ranks as the fifth leading cause of death in the United States, according to Health Research Funding.</p><p>But the consequences of polypharmacy go beyond health outcomes. Residents dealing with polypharmacy also face higher healthcare costs, with expenses nearly doubling compared to those without polypharmacy.</p><h3>The Financial Impact of Polypharmacy on LTC Communities</h3><p>
<strong>Increased Labor Costs</strong><br>With staffing challenges already straining the LTC industry, managing complex medication regimens adds to labor demands and costs. Polypharmacy results in longer med passes, more frequent monitoring, and increased risk of adverse drug events—all of which consume valuable staff time and limit their ability to complete other responsibilities. Often, communities must hire additional staff to manage the workload, compounding financial pressures.</p><p>
<strong>More Care Transitions, Shorter Lengths of Stay</strong><br>Keeping residents in lower-acuity settings is both cost-effective for operators and beneficial for residents. However, polypharmacy increases hospitalizations, emergency visits, and transitions to skilled nursing, shortening length of stay in assisted living. This creates added expenses—such as discharge and readmission coordination, extra nursing hours, and ongoing marketing efforts to replace residents and maintain occupancy—directly impacting the bottom line.</p><h3>Strategies to Reduce Polypharmacy</h3><p>Reducing polypharmacy in LTC settings can be challenging, but several effective strategies can help:<br></p><ol><li>
<strong>Know your residents, their conditions, and medication purposes. </strong>Staff should have a thorough understanding of each resident’s conditions and the purpose behind every medication. This insight helps flag medications that lack a clinical justification or are dosed inappropriately. Staff should feel empowered to consult prescribers or pharmacists, remain alert to side effects, and question prescribing patterns when needed. A team-based, inquisitive approach is key to addressing unnecessary medications.</li><li>
<strong>Engage residents and their families to assess preferences and concerns. </strong>Proactive, face-to-face conversations with residents and families can uncover insights about medication preferences and concerns. Research shows residents are often open to reducing medications—but these discussions typically need to be initiated by clinical staff. By actively listening and relaying feedback to prescribers, staff help tailor safer, more personalized regimens and reduce the risk of adverse events linked to polypharmacy.</li><li>
<strong>Utilize an LTC pharmacy partner and a collaborative approach to reduce polypharmacy.</strong></li></ol><p></p><p>In skilled nursing, the required monthly pharmacist medication regimen reviews focus on identifying and addressing polypharmacy. In assisted living—where consultant pharmacist involvement varies by state—savvy operators partner with LTC pharmacies and adopt a collaborative approach with the broader healthcare team to gain similar benefits. Across all settings, operators should expect their LTC pharmacy partner to:<br></p><ul><li>
<strong>Be an active part of the multidisciplinary care team.</strong> LTC pharmacists are experts in spotting polypharmacy risks. They conduct medication reconciliations during care transitions, simplify regimens, and work collaboratively with residents, families, and the broader healthcare team—including primary care physicians, specialists, and nursing staff—to improve prescribing practices. Consultations should cover high-risk medications, antibiotic and psychotropic use, and prioritize deprescribing opportunities. In assisted living, even quarterly medication regimen reviews can significantly reduce polypharmacy. </li><li>
<strong>Use technology to enhance safety. </strong>LTC pharmacies combine technology and clinical expertise to detect interactions and duplicate therapies. While technology is essential, human oversight ensures its safe and effective use.</li><li>
<strong>Provide proactive interventions and data-driven insights. </strong>Pharmacists should intervene early—before a new medication is dispensed—to monitor outcomes and ensure drug combinations are safe and appropriate. LTC operators benefit from this type of reporting that tracks the pharmacy team’s clinical impact, offering valuable insights to improve resident care.</li></ul><p>
<em>For example, in 2024, Guardian Pharmacy’s proprietary Clinical Intervention program reported more than 112,000 pharmacist-led interventions—identifying over 11,000 instances of duplicate therapy, more than 9,000 cases of unusual dosing (such as doses too high or too low for a resident), and over 28,000 orders that required clarification before dispensing.</em></p><h3>Conclusion</h3><p>Breaking the cycle of polypharmacy is key to improving outcomes and reducing costs. By eliminating unnecessary medications, communities lower the risk of side effects, drug interactions, falls, and hospitalizations. A pharmacist-led, collaborative approach helps optimize regimens and ensure safe, effective care. Communities should rely on their LTC pharmacy partners to lead in this area of expertise, promoting better resident health and long-term financial stability.</p><p>To learn more visit us at <a href="https://guardianpharmacy.com/provider-resources/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">https://guardianpharmacy.com/provider-resources/</a>.<br><br><span class="ms-rteStyle-Normal">References</span><br class="ms-rteStyle-Normal"><span class="ms-rteStyle-Normal">Nguyen PV, Spinelli C. Prescribing cascade in an elderly woman. Can Pharm J (Ott). 2016 May;149(3):122-4. doi: 10.1177/1715163516640811. Epub 2016 Apr 1. PMID: 27</span></p><p>
<span class="ms-rteStyle-Normal">212961; PMCID: PMC4860747.</span><br><br><em><img src="/Articles/PublishingImages/2025/Erin%20Marriott.png" alt="Erin Marriott" class="ms-rtePosition-1" style="margin:5px;width:160px;height:160px;" />Erin Marriott is a board-certified geriatric pharmacist and a seasoned LTC clinical consultant pharmacist. A graduate of the University of Toledo School of Pharmacy and board certified in geriatrics, Marriott has more than 20 years of experience in the long term care industry. She currently serves as the senior director of clinical and regulatory support for
<a href="https://guardianpharmacy.com/provider-resources/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Guardian Pharmacy Services </a>in Atlanta, Georgia, and has an extensive background as a clinical consultant pharmacist, directly serving long-term care and senior living communities for more than 15 years. She is an active member of the American Society of Consultant Pharmacists and has received advanced training in antimicrobial stewardship and anticoagulation management.</em></p> | 2025-05-06T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/medications_4.jpg" style="BORDER:0px solid;" /> | Finance;Management | Erin Marriott | As the older population in the U.S. continues to grow at an exponential rate and develops many of the medical conditions associated with aging, the reliance on multiple medications to address these issues has surged. |
| Iowa Legislature Passes Medical Malpractice Reform Bill Capping Non-Economic Damages for Iowa Nursing Homes | <p><img src="/Articles/PublishingImages/740%20x%20740/gavel_steth.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />The financial stability of the long term care sector requires sufficient revenue and managed costs, and legal liability is one of the largest cost threats facing long term care providers. The Iowa Legislature tackled this threat head-on when it passed <a href="https://www.legis.iowa.gov/legislation/BillBook?ga=90&ba=HF161" target="_blank">HF 161</a>, a bill that caps non-economic damages for health care providers, including nursing homes. Iowa Governor Kim Reynolds signed the bill into law Feb. 16, 2023.</p><p>"Everyone agrees that when mistakes happen Iowans deserve their compensation," said Governor Reynolds when signing the bill into law. “But arbitrary multimillion-dollar rewards do more than that. They act as a tax on all Iowans by raising the cost of care. Protecting our health care system from out-of-control verdicts promotes access to care in communities across our state and better positions us to recruit the best and brightest physicians to Iowa."</p><p>The new law caps non-economic damages—intangible damages such as pain, suffering, or inconvenience—at $1 million for Iowa nursing homes and other health care providers and $2 million for hospitals. Starting in 2028, the caps will increase by 2.1 percent to account for inflation.</p><p>The law became effective immediately upon the governor's signature, and the new limits will apply to any new medical error incidents. Existing lawsuits will be excluded. The law does not limit economic damages, such as money awarded for financial losses, or punitive damages in cases of "willful and wanton disregard" for a patient's safety.</p><p>“This has been a long-time coming," said Iowa Health Care Association's (IHCA) President and CEO Brent Willett. “Significant reform related to legal liability limits has been part of Iowa Health Care Association's legislative platform since 1998. This is a highly important victory for the long-term stability of the nursing home, assisted living, and home health care sectors in our state."</p><p><strong>Medical Malpractice Threats</strong><br>“The threat of legal action from aggressive trial attorneys seeking exorbitant malpractice judgements exacerbates other problems facing Iowa nursing homes—negative operating margins due to astronomical cost inflation, compounded by Medicaid funding shortfalls," added Willett. “Irresponsible claims by trial attorneys often result in exorbitant malpractice judgments, which until now has promoted a negative litigious environment that makes it difficult for providers to maintain operations and plan for the future."</p><p>“I'm grateful to the legislature for passing reasonable medical malpractice reform, allowing Iowa's health care industry to become stronger and more accessible," said Governor Reynolds.</p><p><strong>Difficult Road to Passage</strong><br>“Medical malpractice reform, while critical to the stability of the health care continuum, is a difficult topic to navigate politically, and is a highly sensitive and contentious issue," said Willett.</p><p>Over the past three years, IHCA and the Iowa health care provider community have worked on legislation that would set a hard cap on non-economic damages in medical malpractice suits. In 2021, bills were proposed in the Iowa House and Iowa Senate to set the cap at $1 million. Each year the proposed legislation fell short of the necessary 51 votes in the Iowa House of Representatives.</p><p>This year, Governor Reynolds called for medical malpractice reform to be a priority in her Condition of the State address to the Iowa Legislature upon opening for session in January 2023. After a long and heated debate, the Iowa House passed the bill 54-46 on Feb. 8, and the Iowa Senate passed the bill by a vote of 29-20.<br><strong> </strong><br><strong>Liability Insurance Among Cost Savings</strong><br>From a cost-containment perspective, not only does the new cap protect providers from the threat of aggressive trial attorneys seeing exorbitant malpractice judgements, it also provides savings in the form of liability insurance rates.</p><p>“Data shows the costs for liability insurance was approximately $12.7 million in 2019, and approximately $15.2 million in 2021," said Jeff Steggerda of Brighton Consulting Group.</p><p><img src="/Articles/PublishingImages/2023/RyanHanser.jpg" alt="Ryan Hanser" class="ms-rtePosition-2" style="margin:5px;" />During the early 2000s, nursing homes saw a wave of liability insurance increases that tripled the cost of insurance. IHCA joined the American Health Care Association to study the impact extraordinary claims and settlements were having on the sector's liability insurance rates.</p><p>“The data found liability insurance costs approaching $2,000 per bed or more. The limit of $1 million set by the new law today may seem high, but it should stop or possibly reverse the trajectory of liability insurance premiums and possibly encourage additional companies to enter the market," added Steggerda.<br><strong> </strong><br><em>Ryan Hanser is president at Hanser & Associates, </em><em>a public relations firm.</em></p> | 2023-03-23T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/gavel_steth.jpg" style="BORDER:0px solid;" /> | Finance;Legal | Ryan Hanser | Over the past three years, IHCA and the Iowa health care provider community have worked on legislation that would set a hard cap on non-economic damages in medical malpractice suits. |
| 3 Strategies to Prioritize Accounts Receivable Management | <p><img src="/Articles/PublishingImages/740%20x%20740/healthcare_finance.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />2022 was another big year of regulatory change and financial hurdles for the long term care industry. Long term care operators saw phased Patient Driven Payment Model (PDPM) cuts, the growth of managed care takebacks, and a major draft release of the Minimum Data Set (MDS) 3.0. That is a lot to digest, and this much change means even more research, training, and operational enhancements to make sure communities are accurately reimbursed for the care they provide.</p><p>However, there’s another financial threat that communities should be focusing on in 2023: aging accounts receivable (A/R).</p><p>Facilities across the country are sitting on millions of dollars in unpaid claims due to COVID-19 ripple effects, back-office staffing problems, and increased payor complexity. Operating costs are still up, and the census is still down, putting even more of a financial strain on the facility. Staffing struggles persist, despite raising salaries during the Great Resignation. The costs of clinical supplies, utilities, and resident meals are not decreasing even as inflation plateaus.</p><p>Accounts receivable should not be treated as the drop-off point in the revenue cycle, or the project to be worked on when you have 10 minutes to spare. A facility’s aging A/R is money earned through quality care; it is due to the facility, and it needs to be collected. </p><h3>Professionalize Your Facility’s A/R Management </h3><p>After working in the long term care industry for over 40 years and serving in various positions, such as business office manager, administrative roles, and consultant to the facility owner, here are three strategies I recommend to administrators. These strategies are relevant whether you have a centralized billing office or a one- to two-person team covering the whole back office.</p><h4>1. Review the aging report monthly, at a minimum. </h4><p>Billers should be reviewing the aging report daily. Administrators should review it once a month, at a minimum, to identify trends, determine process improvement priorities, and monitor performance. When reviewing the aging, focus on three key performance indicators: net collections, days sales outstanding, and A/R over 90 days. These metrics define A/R health, help to identify how much and how quickly money was collected, and what amount is at risk of not being collected. <br></p><h4>2. Prioritize claims and make sure the team has dedicated time to work on the A/R. </h4><p>Once the aging has been reviewed, prioritize the workload. There is only so much time in the day and working a single claim can take anywhere from five minutes to two hours or more. The objective is to collect as much money as efficiently as possible; strategizing and working claims systematically will assist with this process.</p><p>Start with claims aged at the timely filing limit to ensure minimal write offs. Secondly, prioritize new aging in the 30-, 60-, and 90-day columns. Lastly, prioritize based on business needs and trends. Remember, there are no unimportant claims; keep in mind how collections can be maximized for staff time and dollars spent. Prioritize the highest dollar claims, or a particular payer that is known to pay slowly. <br></p><h4>3. Champion fixing processes, not just correcting claims. </h4><p>Overstretched teams tend to focus on the immediate billing crisis, not the root cause. Like treating a patient’s symptoms without diagnosing the illness may result in temporary relief, the same problem will keep coming back. As a leader, start asking your team tougher questions during the monthly A/R reviews. What payers have the highest balances? Why? If unknown, what needs to be researched to find out? What is the root cause? Are the payers set up correctly in the A/R system? When was this last checked? Are claims escalated appropriately?</p><p>Consider an A/R assessment from an outside source. These assessments identify aging issues and provide recommendations for communities. Unsurprisingly, if a facility does not have the time or take the time to correct their upstream processes, the frustration will continue with no meaningful progress on the A/R and continued claim denials. <br></p><h3>Collect More with Help </h3><p>Another strategy to get back on track is to outsource your revenue cycle management (RCM) or to bring in a partner for an A/R clean-up. With the right partner, outsourcing RCM can increase collections up to 98 percent. An A/R clean-up will help you catch up on your aging while relieving your team to focus on current billing and broader process improvements. </p><p>The thought of hiring external experts for financial help may seem threatening to the team. They may feel someone is there to criticize and point out all the things they are doing wrong. But, reassuring and supplementing the team with an expert partner will assist with cash flow and getting claims paid, unlock staff time for other priorities, and stabilize the back office. </p><p><img src="/Articles/PublishingImages/2023/Kristy-Brown.jpg" alt="Kristy Brown" class="ms-rtePosition-2" style="margin:5px;width:200px;height:200px;" />“Doing more with less” is a badge of honor in long term care, but our job as leaders is to put a strategy in place that will make our facilities and teams successful.</p><p>Creativity and a sense of partnership will help pave the way for the challenging financial times ahead. Take a closer look at your A/R processes and see what low-hanging-fruit improvements you can make. <br> <br><em>Kristy Brown is the director of skilled nursing facility financial services at Quality Healthcare Resources, an Assembly Health company. She has over 40 years of experience in the long term care industry and was recently recognized with a McKnight’s Long Term Care News Pinnacle Award.<br></em></p><p><em><br></em></p><p style="text-align:center;"><strong class="ms-rteForeColor-2" style="">Learn more:</strong></p><p style="text-align:center;"><em><a href="https://educate.ahcancal.org/RCM"><img src="/Articles/PublishingImages/2023/RCM%20Academy_promo.png" alt="" style="margin:5px;" /></a><br></em></p> | 2023-01-31T05:00:00Z | <img alt="" src="/Articles/PublishingImages/2023/Kristy-Brown.jpg" style="BORDER:0px solid;" /> | Finance | Kristy Brown | A facility’s aging A/R is money earned through quality care; it is due to the facility, and it needs to be collected. |
| Forget the Billing Blues, Sing a Song of Success with OneTouch | <p>Providers and their teams have never been under so much pressure to produce quality outcomes and provide excellent care while managing the bottom line and maintaining census.<br></p><h3>The Team Can Help</h3><p>Billing is always a challenge, but never more so with staffing shortages and other issues contributing to delays, gaps, and errors. The answer is a team of dedicated, knowledgeable partners to take the weight off providers’ shoulders. They get that and more with PharMerica’s OneTouch Billing Support. <br></p><p><img src="/Articles/PublishingImages/Special-Features/2021/1021/bs_Jennifer%20Yowler-2020.jpg" alt="Jennifer Yowler" class="ms-rtePosition-2" style="margin:5px;width:170px;height:213px;" />“Billing is complex. There are many different elements involved to ensure you have accurate statements going out to customers and that claims move through the system quickly and efficiently,” says Jennifer Yowler, chief financial officer of PharMerica. <br></p><p>“When the provider is working with different people or waiting days for call-backs, there are going to be areas where things are not done correctly. With OneTouch, by having a single person responsible for working with each customer and serving as their advocate, we develop a relationship that allows us to understand what the customer needs and work together to create more accurate billing that also lowers costs,” she says. <br></p><p>“We reduce our customers’ workloads, while cutting costs and eliminating claim rejections. At a time when they are watching every dollar, this is extremely important.”</p><h3>Customers Gain an Advocate</h3><p>This isn’t just dedicated customer service. This is white-glove customer experience. Clients don’t just get a personal contact, they get an advocate, a billing and census partner who knows their business and understands their specific needs, goals, concerns, and challenges.<br></p><p>“Their advocate knows the organization’s census and can recognize right away if something is off or doesn’t look quite right,” Yowler says. <br></p><p>“Our people learn all components of billing, and they can pull them all together and be true billing advocates. We also train them on customer service. We’ve invested significantly in training to ensure a full suite of services, all with the customer at the center.”<br></p><p>In the past, Yowler says, “Customers didn’t know who to call in the billing department if they had a question. By putting teams together that work with each customer, they now know who to call and can feel confident that they will get prompt attention from someone who knows them and their organization.” <br></p><p>In developing and refining OneTouch, PharMerica didn’t just guess or assume what their customers want and need. <br></p><p>“As we developed the program, we solicited feedback about how to make sure OneTouch would meet their needs and enhance the customer experience,” Yowler says “Their insights were very valuable in helping us launch a program that would improve their day-to-day functions and make things easier for them and better for their patients and their bottom line.”</p><h3>Driving Accuracy, Savings</h3><p>Working with the OneTouch program and their advocates, customers can feel confident that the appropriate payers are being billed promptly. As a result, payments come in more quickly and more accurately. At the same time, OneTouch team members proactively notify facilities of noncovered and high-dollar medications prior to dispensing. <br></p><p>In fact, OneTouch drives savings at all stages of the census and billing cycle. In addition to personalized customer care, seamless software and eMAR integration improve access to information, transparency, and accuracy. With centralized data, OneTouch also enables insights into recurring issues to help reduce high-cost drives and spend through recommended actions, such as engaging with prescribers and medications that are repeatedly denied. <br></p><p>In a study last year, 94 percent of long term care facilities identified billing efficiency and accuracy as important or very important. OneTouch checks all the boxes and adds the personal touch that not only enables peace of mind but creates partnerships with a common goal of quality care and business success. <br>If any billing concerns arise, they are speedily resolved—typically within 24 hours. Yowler notes, “To keep facilities informed of their efforts, advocates hold weekly calls about what’s in process and what’s been approved or rebilled.”</p><h3>Billing Excellence, Sweet Dreams</h3><p>Providers have a lot to deal with every day—COVID-19 and its aftermath, rebuilding census, connecting residents with their families, and addressing staffing shortages and hiring issues, among other tasks and responsibilities.<br></p><p>“Providers have more challenges than we can imagine,” Yowler says. “One thing we can do is reduce the time they need to manage billing and address problems that arise. If we can reduce their expenses and delays in payment and streamline processes that take burdens off their shoulders, they can focus on resident care and have fewer worries when they turn in at night.” </p><p><br></p><p style="text-align:center;"><img src="/SiteCollectionImages/logos/PharMerica.jpg" alt="" style="margin:5px;width:250px;height:51px;" /><br></p> | 2021-10-01T04:00:00Z | <img alt="" src="/Articles/PublishingImages/Special-Features/2021/1021/JenniferYowler.jpg" style="BORDER:0px solid;" /> | Caregiving;Finance | | Providers and their teams have never been under so much pressure to produce quality outcomes and provide excellent care while managing the bottom line and maintaining census. |