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&#58;5px;width&#58;200px;height&#58;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&#160;it passed <a href="https&#58;//www.legis.iowa.gov/legislation/BillBook?ga=90&amp;ba=HF161" target="_blank">HF 161</a>, a bill that caps non-economic damages for health care providers, including nursing homes.&#160;Iowa Governor Kim Reynolds signed the bill into law Feb. 16, 2023.</p><p>&quot;Everyone agrees that when mistakes happen Iowans deserve their compensation,&quot; 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.&quot;</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&#160;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 &quot;willful and wanton disregard&quot; for a patient's safety.</p><p>“This has been a long-time coming,&quot; 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.&quot;</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,&quot; 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.&quot;</p><p>“I'm grateful to the legislature for passing reasonable medical malpractice reform, allowing&#160;Iowa's health care industry to become stronger and more accessible,&quot; 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,&quot; 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>&#160;</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,&quot; 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&#58;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,&quot; added Steggerda.<br><strong>&#160;</strong><br><em>Ryan Hanser is president at Hanser &amp; 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&#58;0px solid;" />Finance;LegalRyan HanserOver 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&#58;5px;width&#58;200px;height&#58;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&#58; 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&#58; 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&#58;5px;width&#58;200px;height&#58;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>&#160;<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&#58;center;"><strong class="ms-rteForeColor-2" style="">Learn more&#58;</strong></p><p style="text-align&#58;center;"><em><a href="https&#58;//educate.ahcancal.org/RCM"><img src="/Articles/PublishingImages/2023/RCM%20Academy_promo.png" alt="" style="margin&#58;5px;" /></a><br></em></p>2023-01-31T05:00:00Z<img alt="" src="/Articles/PublishingImages/2023/Kristy-Brown.jpg" style="BORDER&#58;0px solid;" />FinanceKristy BrownA 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&#58;5px;width&#58;170px;height&#58;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&#58;center;"><img src="/SiteCollectionImages/logos/PharMerica.jpg" alt="" style="margin&#58;5px;width&#58;250px;height&#58;51px;" /><br></p>2021-10-01T04:00:00Z<img alt="" src="/Articles/PublishingImages/Special-Features/2021/1021/JenniferYowler.jpg" style="BORDER&#58;0px solid;" />Caregiving;FinanceProviders 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.
AHCA, NCAL Letter to HHS Requests Immediate Release of Funds<p>​​COVID-19 and the recent explosion of the Delta variant continue to impact thousands of skilled nursing and assisted living facilities across the country, the American Health Care Association/National Center for Assisted Living told Department of Health and Human Services (HHS) Secretary Xavier Becerra in a <a href="http&#58;//links.ahca.org/u/click?_t=3abc5280edfa42b5905fbea7c0fff5c2&amp;_m=4f26a3f3edf3408d82bdda9bb7474188&amp;_e=96DTAwZbnOWclPYA7fpbRyOzJzJQ-_0S3tLsZRIjUcodQ8YNatF0Fm_GNT-S0DsYr3i4HaSCkxZSFgVw30cGkGCC8Hsy9qz8d4d0Dy0eSyKP12NEXoTCmxyRcD_pwdZzwiH-YEvli-M1Hj3msLegkFB_Nw5BBRaXsrPMs8hrH4hCopNbAaGqqGr5r1MU2kg_DgqPx5VnljTAzds_f2as5_khuQwnWROLPmD4lN2XA8qwmGsmxwoP4LMS-XBM8rNhp5mEbm6NpnnfgvFWqjbXJp7cKUT_Gp8Ndx8gERloEINXUUY70nwBRhw9DVGt2fGvcbco_HgiMTngph0DSWYmZw7o-yPKWOCVq5RIIdoTzdsZ7QM-6ItyIHXPIrAUlrc2" target="_blank">letter</a> this week. The association is requesting that remaining resources in the Provider Relief Fund (PRF) be released immediately to health care providers, including long term care facilities.&#160;<br></p><p>In 2020, nursing homes received $13 billion of the $178 billion of the PRF, which for many providers made the difference between keeping their doors open or shutting them for good, AHCA/NCAL said. Currently, approximately $44 billion remains in the fund; however, nothing has been distributed in 2021. In the face of mounting new cases due to Delta, the association urged the administration to prioritize its residents and frontline health care workers before the situation gets worse.&#160;</p><p>During the pandemic, nursing homes have faced increased expenses for personal protective equipment (PPE), testing, and additional staffing to ensure residents and caregivers remain protected from COVID-19. In 2020, providers spent <a href="http&#58;//links.ahca.org/u/click?_t=3abc5280edfa42b5905fbea7c0fff5c2&amp;_m=4f26a3f3edf3408d82bdda9bb7474188&amp;_e=96DTAwZbnOWclPYA7fpbR_tBiRCgH1c4rEjVyAb-Iczo62zPmima9ZOGzRl6M7swFu_UdDr5dV1-DzKRHJWqyITYUfom481v9njlp07fEeeyBqYITUhg4xG7PBADCzfERD_GmwDOe70UVyb6Jg1x3EC_ZXVGILsEY3K_sm-y_h8KEZpvsCV8STP8_rdPLisUCT5oMlmG-URJhp4-wyf16YiS0TLicFnx7f0AmFQfZz91yjIapCY8S4pK7SfeN0eOf-XSKz7SgLJKH6mbTsYkbzKGaby6L6Qqw-dOtgoBfuHamRot2UyrmV2wPZQLrCE-2_EmzLZ-EhHgEiRCdtt99K2tuiQ6NBlUqyAnXwsHbQR-SWsFnbdf4SC7J4_3y95XD9EArJz1kbyw88oYPcWpKA%3D%3D" target="_blank">$30 billion</a> on PPE and staffing alone. But as the pandemic continues, these costs will remain constant, the association said. By the end of 2021, providers are projected to spend $60 billion on pandemic-related costs in the span of two years.&#160;</p><p>These additional costs are causing a major strain on facilities that have long struggled to break even. Medicaid—the primary payer for nursing homes residents—has been historically underfunded. The amount that providers are reimbursed only covers between 70 and 80 percent of the total cost of care, AHCA/NCAL said. This chronic gap in funding has left many providers operating on shoestring budgets year after year.&#160;</p><p>Providers across the country are seeking to hire more staff, but many lack the financial resources to offer competitive wages. In a recent AHCA/NCAL survey, 81 percent of nursing home providers and 75 percent of assisted living communities said higher Medicaid reimbursement to offer staff better pay and benefits would help improve their ability to recruit and retain staff members.</p><p>In addition to bolstering the long term care workforce, proper financial support will help prevent widespread closures. AHCA/NCAL estimates that <a href="http&#58;//links.ahca.org/u/click?_t=3abc5280edfa42b5905fbea7c0fff5c2&amp;_m=4f26a3f3edf3408d82bdda9bb7474188&amp;_e=96DTAwZbnOWclPYA7fpbR_tBiRCgH1c4rEjVyAb-Iczo62zPmima9ZOGzRl6M7swFu_UdDr5dV1-DzKRHJWqyITYUfom481v9njlp07fEeeyBqYITUhg4xG7PBADCzfERD_GmwDOe70UVyb6Jg1x3EC_ZXVGILsEY3K_sm-y_h9Ekx1oSO25ygu7qcyBQquJsmGvBJ-KwjOsfnT4fCbCd2A5FpBkxiCNozzpfK3vF3H4B5s1Y6Dqjw_BgtbUkQzOR9thaRWj36XMrWnyzYm4wyQNpWRhkbG8tDsGXCY8psCUQOMNWAfj1Q12USVxDT1qEl7YoX-KaOnhz3BJkkursy4329eo18S01GG6_IWfaXAqMpRiZDak6bNtKit0Wb2-wBA1nynCpTsLxU8UpCLW0w%3D%3D" target="_blank">nearly 2,000</a> nursing homes could permanently close their doors over a two-year period (2020-2021).</p><p>In the letter, AHCA/NCAL President and Chief Executive Officer Mark Parkinson said, “The staff and residents in skilled nursing facilities around the country desperately need ongoing support in facilities most affected by the virus. Ensuring that this funding is delivered to long term care providers immediately is critical to our primary role of caring for and protecting our nation's seniors and most vulnerable.&quot;<br></p><p>​</p>2021-08-11T04:00:00Z<img alt="" src="/Articles/PublishingImages/740%20x%20740/0820_News1.jpg" style="BORDER&#58;0px solid;" />COVID-19;FinanceJoanne EricksonExtra costs from COVID are causing a major strain on facilities that have long struggled to break even.