9/30/2018 1 9/30/2018 Long Term Care Payments in a Changing - - PDF document
9/30/2018 1 9/30/2018 Long Term Care Payments in a Changing Landscape NCPA 2018 Annual Convention Frank Grosso, RPh, HealthCare Consults, LLC Principal Disclosure Frank Grosso is the Principle of HealthCare Consults. The conflict of
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NCPA 2018 Annual Convention
Frank Grosso, RPh, HealthCare Consults, LLC Principal
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the independent pharmacy LTC operators.
and beyond that may affect the LTC market for the independent practitioner.
recent CMS regulations and its implications for skilled nursing facility revenue.
1965 1965
1974 1974
1980s 1980s
1990s 1990s
2000s 2000s
2010s 2010s
PPS Part D ACA
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AHCA/NCAL Set 2018 goals to improve nursing home quality of care:
discharge rate of at least 70%
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Skilled Nursing News, Nov 30, 2017
“Reimbursement and occupancy challenges facing our entire industry have negatively impacted the Genesis HealthCare stock price and those of other providers in the industry,” CEO George Hager said in a statement.
Skilled Nursing News, March 2, 2018
“Toledo, Ohio-based ManorCare, one the largest skilled nursing providers in the nation, is expected to file for Chapter 11 bankruptcy protection”.
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“Skilled nursing continues to have the weakest inventory growth out of long-term care property types, with independent living leading the pack… the nursing care segment had the weakest overall inventory at -0.4%, a 2 percentage-point decline in occupancy”. Skilled nursing growth continues to lag, NIC* finds “The independent living segment, housing seniors who require the lowest level of care, saw 5.7% inventory growth. Occupancy only decreased by 0.3 percentage points, from 91% to 90.7%”.
*National Investment Center for Seniors Housing & Care (NIC)
Anthem profits skyrocket 234%, Healthcare Finance, February 1, 2018, Available at: http://www.healthcarefinancenews.com/news/anthem-profits-skyrocket-234
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March 13, 2018 How In-House Insurance Plans Can Boost Skilled Nursing’s Fortunes 1 “The Milwaukie, Ore.- based Marquis Companies, which operate 18 skilled nursing facilities and five assisted living communities, launched its AgeRight Advantage I-SNP plan in January, 2017. So far, the program has netted Marquis $10 million in revenues, and helped to position the provider in the overall managed care landscape — an area of the skilled nursing world that’s rapidly growing.”
1. https://skillednursingnews.com/2018/03/house-insurance-plans-can-boost-skilled-nursings-fortunes/ 2. https://skillednursingnews.com/2018/03/house-insurance-plans-can-boost-skilled-nursings-fortunes/
April 3, 2018 Providers Move Into Insurance to Ride Medicare Advantage Momentum 2 “As of March of this year, there are 49 contracts with Medicare covering 97 I-SNPs, with a total of 73,472 enrollees, according to data from CMS’ Health Plan Management System. One of those I-SNPs is Great Plains Medicare Advantage, which offers plans in South Dakota, North Dakota, and Nebraska — and is owned by the Evangelical Lutheran Good Samaritan Society, a not-for-profit that provides a variety of senior care services, including skilled nursing, in 22 states.”
“As the popularity of Medicare Advantage plans continues to grow, commercial health insurers are starting to look at senior living not only as a partner but as a potential acquisition target.” “While the number of senior living providers partnering with Medicare Advantage programs is small, the opportunity is significant and will only get bigger, according to Dan Mendelson, president of Washington, D.C.-based consulting firm Avalere Health, a subsidiary of Inovalon."
Medicare Advantage Insurers Consider Senior Living Acquisitions, Senior Housing News, Yedinak, John, March 27, 2018. Available at: https://seniorhousingnews.com/2018/03/27/medicare-advantage-insurers-consider-senior-living-acquisitions/
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“The Centers for Medicare & Medicaid Services on Thursday issued a
notice of proposed rulemaking that would ease some regulatory requirements for states offering Medicaid Advantage programs.” “The proposal would exempt states from analyzing certain data and monitor access to fee-for-service plan when the vast majority of covered residents receive services through managed care plans.”
McKnight’s: March 23, 2018, Kimberly Marselas
DRGs Medicare Only DRGs – For Non- Medicare
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HCFA Introduced 1983 DRGs
Source: ASCP estimate calculated from CMS MDS Data, Prepared by AHCA:Discharges to Community, defined as individuals who are discharged back to the community alive (i.e., private home, apartment, board/care, assisted living, or group home, as indicated on the MDS discharge assessment form) from a skilled nursing center within 100 days of admission and remain out of any skilled nursing center for at least 30 days
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15,400 15,500 15,600 15,700 15,800 15,900 16,000 16,100
400,000 600,000 800,000 1,000,000 1,200,000 1,400,000 1,600,000 1,800,000 Jan-05 Jan-06 Jan-07 Jan-08 Jan-09 Jan-10 Jan-11 Jan-12 Jan-13 Jan-14 Jan-15 Jan-16 Jan-17 Jan-18 Mar-05 Mar-06 Mar-07 Mar-08 Mar-09 Mar-10 Mar-11 Mar-12 Mar-13 Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Certified Beds 1,678,634 1,674,807 1,671,645 1,668,815 1,666,800 1,665,845 1,671,226 1,667,884 1,667,033 1,663,537 1,662,757 1,662,070 1,661,184 1,661,057 Patients in Certified Beds 1,434,812 1,430,367 1,426,460 1,415,915 1,407,975 1,397,149 1,394,537 1,386,097 1,380,718 1,368,986 1,368,351 1,347,073 1,336,299 1,333,799 Certified Facilities 16,012 15,914 15,823 15,726 15,684 15,665 15,679 15,673 15,668 15,650 15,632 15,651 15,646 15,647 Certified Beds Patients in Certified Beds Certified Facilities
17,577 Fewer Beds
Source: Computed from AHCA research staff using CMS NF standard health survey data.
Source: U.S. Census Bureau, 2012 Population Estimates and 2012 National Projections
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2012 2020 2030 2040 2050 85 years and older (Millions) 5.9 6.7 8.9 14.1 18 5.9 6.7 8.9 14.1 18 2 4 6 8 10 12 14 16 18 20
85 years and older (Millions)
Source: U.S Census Bureau, 2012 Population Estimates and 2012 National Projections
“The global home healthcare market size is anticipated to reach USD 517.23 billion by 2025, according to a new report by Grand View Research, Inc., progressing at a CAGR of 7.8% during the forecast period.”
Home Healthcare Market Analysis Report By Component (Equipment (Diagnostic, Therapeutic, Mobility Assist), Services (Rehabilitation, Infusion Therapy, Respiratory Therapy Services)) And Segment Forecasts 2018 – 2025, Grandview Research, August, 2018, Available at: https://www.grandviewresearch.com/industry- analysis/home-healthcare-industry
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Growth in the senior living industry tracks closely with the older adult population in the U.S. in recent years. Between 2001 and 2014, the number of senior living communities increased 39%. During the same period, the U.S. population aged 85 and older rose 43%. As a result of the similar growth rates, the number of senior living communities as a proportion of the senior population has been relatively steady.
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14%
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PAC PAC PAC
Source: Chandra, A., Dalton, M., Holmes, J., “Large Increases in Spending on Postacute Care In Medicare Point to the Potential for Cost Savings in these Settings”, Health Affairs, August 2013, available at: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2012.1262#EX4
Rx $’s Rehab $’s LOS $’s
ACO & Managed Care
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leverage referrals in exchange for influence
Agreement to collect specific quality metrics Sharing access to electronic medical records Hold regular meetings and performance reviews Dedicated care coordination
1.Huckfeldt, Peter, Do Skilled Nursing Facilities Selected to Participate in Preferred Provider Networks Have Higher Quality and Lower Costs?, Health Services Research, Available at: https://doi.org/10.1111/1475-6773.13027
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RUG-IV
Therapy Nursing
PDPM
10 classification PT OT SLP NTA Nursing
INCLUDES Rx
RUG-IV
payment
therapy utilization
during LOS
PDPM
impact on reimbursement
medically complex patients
based on patient need
then reduced after 3 days
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Skilled Nursing Facility Payment Models: Nursing ComponentTechnical Expert Panel, Acumen, LLC, November 19,2015
RUG-IV
Groups
PDPM
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Lower Cost
Fee For Service Moving to Fee Per Episode
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Rx $’s Rehab $’s LOS $’s
ACO & Managed Care
CCRC ALF CPs Pharmacy NHs Home Care Insurance Hospital PCP
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Principal HealthCare Consults, LLC frank.grosso74@gmail.com