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Insurance Corner <p><strong class="ms-rteForeColor-2">ADVERTORIAL</strong></p><p><img src="/SiteCollectionImages/logos/CompassTB.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;150px;height&#58;150px;" />​&quot;One of the things that has worked well for us is Compass Total Benefit Solutions’ ability to manage change and transitions seamlessly. About 15 months ago, Altamonte Care of Texas changed payroll platforms. Compass was highly engaged in our strategic process of choosing a new platform for our company.<br></p><p>“Nick, our partner at Compass, was familiar with our business. We built trust together over time, as Nick had helped our business create a strong benefits package and manage benefits during a period of growth and acquisition. <br></p><p>“Compass’ recommendation to use Employee Navigator for benefits enrollment allowed us to seamlessly integrate the new payroll platform and human resources information system. Employees can access the platform from their own device and see their payroll information, benefits details and other helpful information, like ongoing education and training requirements. At the same time, our operations and departments are streamlined, and we’re poised for easier growth.<br></p><p><span><img src="/Topics/Special-Features/PublishingImages/2022/LoganSaxton_Compass.jpg" class="ms-rtePosition-1" alt="" style="margin&#58;5px;" /></span>“Compass is really the leading expert in creating insurance and benefits programs that truly work for your business. Culturally, our company aims to always be compassionate. We want to make the right decisions when it comes to our employees’ wellness, whether that’s their emotional, physical or financial health, and I trust Compass to help us live out that mission in every aspect.”<br></p><p>Logan Sexton, Managing Principal<br>Altamonte Management Advisors, LLC <br><a href="mailto&#58;logan.sexton@altamontecare.com" target="_blank">logan.sexton@altamontecare.com</a></p><p><br></p><p>To learn more about Compass, visit <a href="http&#58;//compasstbs.com/" target="_blank">compasstbs.com</a> or contact Nick Cianci at <a href="mailto&#58;nick@compasstbs.com" target="_blank">nick@compasstbs.com</a>.<br> </p>2022-06-01T04:00:00Z<img alt="" src="/SiteCollectionImages/logos/CompassTB.jpg" style="BORDER&#58;0px solid;" />Management​"One of the things that has worked well for us is Compass Total Benefit Solutions’ ability to manage change and transitions seamlessly."
A View from the Field<p><img src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/MatthewBarrett.jpg" alt="Matthew Barrett" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;125px;height&#58;143px;" /><span class="ms-rteThemeForeColor-5-4">​“COVID-19 relief dollars provided by both federal and state government have been nothing short of a lifeline for our Connecticut nursing homes hit hard by the pandemic and now on a pathway toward recovery, but a longer bridge or recovery period of support to the other side of the pandemic is needed beyond what was initially forecasted. Occupancy recovery is now the main issue in the elongated pandemic, and how staffing shortages are hindering occupancy recovery is the same issue at both the federal and state level.”</span><br><span class="ms-rteFontSize-1">—&#7;Matthew V. Barrett, J.D., M.P.A., President and CEO, Connecticut Association of Health Care Facilities and Connecticut Center for Assisted Living</span></p><p><br></p><p><img src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/RobertVandeMerwe.jpg" class="ms-rtePosition-2" alt="Robert Vande Merwe" style="margin&#58;5px;width&#58;125px;height&#58;125px;" /><span class="ms-rteThemeForeColor-9-4">“I believe the greatest challenge both in Idaho and nationally is the workforce crisis. We always knew that there would not be enough workers to support the Baby Boomers after 2030, but the pandemic has brought that crisis eight years earlier as millions have left the workforce.”</span><span class="ms-rteFontSize-1"><br></span></p><p style="text-align&#58;right;"><span class="ms-rteFontSize-1">—&#7;Robert Vande Merwe, Executive Director, Idaho Health Care Association</span></p><p><br></p><p><img src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/BrendanWilliams.jpg" alt="Brendan Williams" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;125px;height&#58;143px;" /><span class="ms-rteThemeForeColor-7-4">“The predations of national staffing agencies threaten to destroy long term care in New Hampshire and nationally. Having a staffing agency in your building is like inviting in a vampire.”</span><br></p><p><span class="ms-rteFontSize-1">&#160;—&#7;Brendan W. Williams, M.A., J.D., President and CEO, New Hampshire Health Care Association</span></p><p><br></p><p><br></p><p><img src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/CherylHeiks.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;125px;height&#58;125px;" /><span class="ms-rteThemeForeColor-10-3">“The pandemic represents the greatest threat to the industry in its history. But with every threat, there exists the chance for opportunities. The crisis should be the clarion call to stakeholders beyond the industry who were already painfully aware of staffing shortages. The lack of supply of health care professionals in the country because of increased competition, the aging of the existing workforce, and traditionally lower wages and health benefits in the long term care industry will add to the challenge.”</span></p><p style="text-align&#58;right;"><span class="ms-rteFontSize-1">—&#7;Cheryl Heiks, Executive Director, Delaware Health Care Facilities Association</span></p><p><br></p><p><img src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/KevinWarren.jpg" alt="Kevin Warren" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;125px;height&#58;143px;" /><span class="ms-rteForeColor-6">“I believe nationally, the greatest issue facing long term care is a true lack of understanding of the economic and societal role the nursing home profession serves in communities (urban and rural) across the country. They are the support for a disappearing safety net as the population over 65 grows faster and the availability of family caregivers declines. In communities across the country, nursing homes are among the top employers, nationally generating billions of dollars in labor income, state and local tax revenues.</span><br class="ms-rteForeColor-6"></p><p><span class="ms-rteForeColor-6">“The biggest short-term issue facing long term care in Texas is the inevitable expiration of the federal public health emergency and the end of Medicaid add-on in place that has served as a lifeline for long term care. Long term, the biggest issue in Texas is the lack of a predictable Medicaid policy that pays for actual costs of care, adjusts to the growing acuity needs, and ensures the availability of resources to provide the highest quality of care our residents/</span><br class="ms-rteForeColor-6"><span class="ms-rteForeColor-6">patients deserve.”</span><br></p><p><span class="ms-rteFontSize-1">—&#7;Kevin Warren, President and CEO, Texas Health Care Association<br></span></p><p><br><span class="ms-rteFontSize-1"></span></p><p><img src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/PattiCullen2.jpg" alt="Patti Cullen" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;125px;height&#58;143px;" /><span class="ms-rteForeColor-1">“Workforce availability is the biggest issue—it has always been a small concern, but current labor market competition, suppressed wages, and a decreasing number of eligible workers have created a workforce crisis that is not easily resolved. Simply legislating or regulating workforce standards does not solve this problem; rather, significantly increasing wages and benefits to entice workers to join and stay in the long term care profession as a valued career is essential to avoid collapse of this sector.”</span><br></p><p style="text-align&#58;right;"><span class="ms-rteFontSize-1">—&#7;Patti Cullen, CAE, President and CEO, Care Providers of Minnesota</span></p><p><br></p><p><img src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/RachelBunch.jpg" alt="Rachel Bunch" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;125px;height&#58;125px;" /><span class="ms-rteForeColor-9">“The biggest issue facing our sector nationally is funding, which affects all areas of a quality delivery service, especially access to care in rural America. The biggest issue facing our state is workforce, in particular the shortage of nurses.”</span><br></p><p><span class="ms-rteFontSize-1">—&#7;Rachel Bunch, Executive Director, Arkansas Health Care Association and Arkansas Assisted Living Association</span></p><p><br></p><p><img src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/RickAbrams.jpg" alt="Rick Abrams" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;125px;height&#58;143px;" /><span style="color&#58;#ff9900;">“No question that in Wisconsin and nationally the biggest issue is workforce. Our members are continually challenged to maintain adequate staff coverage in all operational areas so that they can continue to deliver the high quality care that our seniors and folks living with disabilities expect and, indeed, deserve.” </span><br></p><p style="text-align&#58;right;"><span class="ms-rteFontSize-1">—&#7;Rick Abrams, CEO, Wisconsin Health Care Association/Wisconsin Center for Assisted Living</span></p><p><br></p><p><img src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/ZachShamberg.jpg" class="ms-rtePosition-1" alt="Zach Shamberg" style="margin&#58;5px;width&#58;125px;height&#58;143px;" /><span style="color&#58;#0099ff;">“At both the state and federal level, the biggest issue facing the long term and post-acute care sector will be securing a seat at the table for policy, regulatory, and legislative discussions. As we continue to see new reform after new reform introduced by CMS and state legislatures throughout the country, we’ll need to ensure long term care providers can share their expertise and experience to help shape policy. Otherwise, the future of our industry will be dictated by those who never spent a single day on the front lines of the COVID-19 pandemic and who couldn’t possibly understand the challenges we face.”</span><br></p><p><span class="ms-rteFontSize-1">—&#7;Zach Shamberg, President and CEO, Pennsylvania Health Care Association</span><br></p>2022-06-01T04:00:00Z<img alt="" src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/RobertVandeMerwe.jpg" style="BORDER&#58;0px solid;" />Caregiving;ManagementAHCA/NCAL State Executives and leaders weigh in on what they see as the sector’s biggest challenges and what issues they are facing head-on in their local communities.
The State of the Sector<p>Thousands of long term and post-acute care professionals are facing very real impacts that decisions made in Washington, D.C., have on centers across the nation. This year, two issues have risen to the top of the list of priorities for those advocating for the industry&#58; the Centers for Medicare and Medicare Services’ (CMS) Fiscal Year (FY) 2023 Proposed Payment Rule and the ongoing workforce shortage within long term and post-acute care. Read on for details of each issue and how leaders can ask for the best solution from their elected officials at the local, state, and federal levels. </p><h2>Issue 1&#58; CMS Payment Rule</h2><p><strong>CMS has proposed a payment rule that would negatively impact the skilled nursing facility (SNF) sector by $320 million</strong>.<br><br><span class="ms-rteForeColor-2">The Request&#58;</span> CMS should consider public comments from the sector regarding the appropriate percentage methodology before determining the final parity adjustment. CMS also should work with the sector to ensure the annual Market Basket update adequately accounts for labor cost increases. CMS should phase in any reduction over three years to allow the sector to create realistic adjustments in operations to guarantee the continuity of quality care.<span class="ms-rteForeColor-2"><br></span></p><p><span class="ms-rteForeColor-2">The Background&#58;</span> For FY 2023, CMS has proposed a skilled nursing facility net rate cut of 0.7 percent, resulting from a 3.9 <span>percent</span> adjusted market basket increase offset by a 4.6 <span>percent</span> parity adjustment reduction. CMS is proposing a parity adjustment to ensure costs under the new payment system, the Patient-Driven Payment Model (PDPM), are no more than under the old payment system. CMS is not required by law to use a budget neutral transition. Due to the proposed parity adjustment, CMS estimates that the net market basket update would decrease Medicare SNF payments by approximately $320 million. The SNF sector cannot absorb such a cut.</p><p><span class="ms-rteForeColor-2" style="">The Impact&#58;</span> Due to ongoing workforce issues and low occupancy rates, labor costs have increased by nearly 18 <span>percent</span> in a single year, according to the Clifton Larson Allen State of the SNF Industry Report published in February 2022. These increased costs, combined with a nominal improvement in census rates from about 73&#160;<span>percent</span> to 76&#160;<span>percent</span> in 2022, mean residents and patients are facing a real risk of displacement as centers grapple with sustaining operations on a projected negative 4.8&#160;<span>percent</span> margin. This CMS rate cut would increase the projected margin to -5.9 <span>percent</span>, creating additional risk of closures and displacement. </p><h2>Issue 2&#58; The Workforce Crisis</h2><p><strong>Providers are experiencing a loss of staff due to pandemic impacts and lack of supply and availability of staff to fill vacancies</strong>.<br><br class="ms-rteForeColor-2"><span class="ms-rteForeColor-2">The Request&#58;</span> Policymakers must prioritize the nation’s caregivers with the resources and support they deserve, specifically through the recruitment and retention of the long term care workforce.<span class="ms-rteForeColor-2"><br></span></p><p><span class="ms-rteForeColor-2">The Background&#58;</span> A recent report from AHCA/NCAL summarized Bureau of Labor Statistics (BLS) data showing that that long term care facilities have lost more than 400,000 caregivers since the beginning of the pandemic, more than any other health care sector. According to the BLS, overall long term care workforce levels are the lowest they have been in 15 years. Nearly every nursing home and assisted living community in the United States is facing a workforce crisis<br></p><p>In addition, the issue of potential anti-competitive practices by temporary staffing agencies is a concern in nursing homes and assisted living communities. At a time when long term care facilities are struggling to make sure they have enough staff to serve their residents and keep their doors open, staffing agencies are charging exorbitant rates and giving only a fraction to their clinical personnel.</p><p><span class="ms-rteForeColor-2">The Impact&#58;</span> Without support from policymakers, the long term care sector is facing decisions and scenarios that put the care of our nation’s seniors and individuals with disabilities at risk. Staffing shortages are forcing many facilities to limit admissions or close their doors completely. Notably, at least 75 <span>percent</span>of operators had to limit admissions in 2021 due to a lack of staff, according to a survey of more than 300 long term care owners, operators, and administrators. More than 300 nursing homes have closed since the pandemic began, according to data available through Quality, Certification, &amp; Oversights Reports. The sector cannot continue without new and/or reinforced support from the nation’s leaders.<br></p><p>To learn how to get involved in your community’s grassroots advocacy efforts, contact AHCA/NCAL’s Advocacy team at <a href="http&#58;//www.ahcancal.org/advocacy" target="_blank">www.ahcancal.org/advocacy</a>.<br></p>2022-06-01T04:00:00Z<img alt="" src="/Topics/Special-Features/PublishingImages/2022/JuneJuly/060722_sector.jpg" style="BORDER&#58;0px solid;" />Capitol HillThis year, two issues have risen to the top of the list of priorities for those advocating for the industry: the Centers for Medicare and Medicare Services’ (CMS) Fiscal Year (FY) 2023 Proposed Payment Rule and the ongoing workforce shortage within long term and post-acute care.
Ensuring Continuing Care After the Transition Home<p><span class="ms-rteForeColor-2"><strong>ADVERTORIAL</strong></span></p><p>Today’s health care professionals are continually doing more with less. Day in and day out, skilled nursing facilities and post-acute care centers are balancing their biggest priority—delivering quality care to residents and patients—with new and shifting challenges like workforce shortages and agency costs. For these reasons and more, finding reliable partners across the continuum of care is becoming an increasingly important aspect of any center’s long-term success. <br></p><p>Continue Care is a new transitional care management program from the trusted partners at PharMerica and BrightSpring Health Services’ family of providers. This program aims to address the gaps in care that exist when an individual is transitioning from a skilled care facility to their own home. <br></p><p><img src="/Topics/Special-Features/PublishingImages/2022/JeremyColvin.jpg" class="ms-rtePosition-1" alt="Jeremy Colvin" style="margin&#58;5px;width&#58;125px;height&#58;156px;" />“There is an obvious and palpable loss of visibility when individuals move from a skilled nursing care center to their own residence,” said Jeremy Colvin, PharMerica’s Senior Vice President, Growth and Market Development. “From the moment a person goes to the hospital or care center, they have a care plan in place. In too many cases, this care plan effectively stops when the individual is discharged. Most skilled nursing care centers aren’t equipped to follow individuals as they adjust at home, and unfortunately, this is a critical time in a person’s health.”<br></p><p><span></span>By combining PharMerica’s pharmacy services with home-based primary care and nurse outreach services from BrightSpring Health Services’ family of providers, Continue Care aims to be the partner that skilled nursing facilities can rely on to ensure the success of their residents as they transition home. <br></p><p><span><span><img src="/Topics/Special-Features/PublishingImages/2022/JuneJuly/ShauenHoward_pharm.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;125px;height&#58;143px;" /></span></span>“I have been doing in-home patient visits for more than 22 years,” said Dr. Elizabeth Shauen Howard, DHA, MSN, RN, COS-C, Vice President of Clinical Services and Innovation for BrightSpring. “The biggest single risk factor for individuals who are managing their own care at home is medication management. Prescriptions can be difficult to keep organized, and adherence to their prescription program is essential for maintaining health at home.”</p><p>In Dr. Howard’s experience, the scene is similar in many patients’ homes. They’ve just come home from the skilled nursing care center, where they were cared for by a team of professionals. Their meals were cooked for them, activities were planned, medications were managed on strict timelines, and household items like laundry and cleaning were handled by staff or loved ones. Suddenly, they’re back in their home, sometimes alone. Previously prescribed medications often still remain in the home, creating confusion about which medications to take and at what times. Their bedroom may be on the second floor, and they aren’t strong enough yet to safely go up and down the stairs. <br></p><p><img src="/Topics/Special-Features/PublishingImages/2022/WilliamMills.jpg" alt="Bill Mills" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;125px;height&#58;156px;" />“From a patient’s standpoint, this can be a very overwhelming time for a person as they transition from a hospital or a skilled nursing care center to their home,” said Dr. Bill Mills, Senior Vice President of Medical Affairs for BrightSpring. “Medicare has recognized the fact that coordination between sites of care is critical, and, as a field, we need to optimize transitions of care. It’s the right thing to do.”<br></p><p>A lack of support during this transition—and the many changes residents face when they get back home—have real impacts for both the individuals and their care providers. One in every five people who are discharged from an acute care setting is readmitted to a hospital within 30 days. This may be due to difficulty understanding discharge instructions and medication regimens, inadequate follow up and referrals, and unmet social needs.<br></p><p>The answer to this challenge is creating a better support system for individuals as they transition home. Continue Care integrates seamlessly into a facility’s discharge planning process to extend care management into the home by offering&#58;</p><p dir="ltr" style="text-align&#58;left;">■ A 14-day supply of medications for residents to take with them when they leave plus up to an additional 30-day supply reviewed and reconciled by a pharmacist and delivered to their home in easy-to-use packaging to improve access and adherence.</p><p dir="ltr" style="text-align&#58;left;">■ Weekly phone calls from a nurse starting within 48 hours of the resident’s return home to check on medication issues or health changes.</p><p dir="ltr" style="text-align&#58;left;">■ An in-home transitional care visit within days from one of the company’s medical providers, where available, to conduct a physical assessment and evaluate needs for skilled and unskilled care (with in-home medical care continuing thereafter on a patient-by-patient basis).</p><p dir="ltr" style="text-align&#58;left;">■ 24/7 nurse and pharmacist support for residents and their families.</p><div class="ms-rteElement-BlockQuoteLeft"><span class="ms-rteFontSize-1">7 proven ways skilled nursing facilities can support care transitions <br>1. &#7;Conduct transition planning.<br>2. &#7;Provide patient and family education.<br>3. &#7;Oversee information transfer.<br>4. &#7;Ensure follow-up care.<br>5. &#7;Facilitate healthcare provider engagement.<br>6. &#7;Demonstrate shared accountability across providers and organizations.<br>7. &#7;Provide medication management.</span></div><p>In addition to helping the patient feel supported and secure at home, the Continue Care program has a direct impact on care centers, too. Studies have shown that home-based primary care is associated with a 50 percent reduction in hospital readmissions and a 20 percent reduction in emergency room visits. The readmissions rate of nursing facility patients back to the hospital is directly related to facility reimbursements, meaning fewer readmissions financially benefits centers. <br></p><p>“Implementing a program like Continue Care signals to other care providers that a center is doing what it needs to do to care for its residents and providing the support they need to stay healthy at home and prevent a readmission,” said Colvin. “Referral partners are going to shift dramatically based on who is sending people back to the hospital.”<br></p><p><img src="/Topics/Special-Features/PublishingImages/2022/ContinueCarePharmerica.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;190px;height&#58;57px;" />All Continue Care services are provided at no cost to facilities or residents; residents are responsible for their regular copayment based on their pharmacy coverage. To learn more about implementing Continue Care, visit <a href="http&#58;//www.pharmerica.com/ContinueCare" target="_blank">www.PharMerica.com/ContinueCare</a>.​</p>2022-06-01T04:00:00Z<img alt="" src="/Topics/Special-Features/PublishingImages/2022/ContinueCare_PharMerica.jpg" width="1248" style="BORDER&#58;0px solid;" />CaregivingOne in every five people who are discharged from an acute care setting are readmitted to a hospital within 30 days.