The landscape at skilled nursing facilities is evolving rapidly, influenced by factors such as changing regulations, workforce challenges, and the rise of Medicare Advantage, and the minimum staffing proposal only complicates matters.
This view was expressed by industry leaders in the opening session of the Skilled Nursing News’ RETHINK conference Wednesday. Panelists – Wesley Rogers, CEO of Brickyard Healthcare, Phil Scalo, CEO and founder of Bartley Healthcare and Vice Chair of the American Health Care Association (AHCA), and Erin Shvetzoff Hennessey, CEO of Health Dimensions Group – shared their perspectives during a discussion on the topic.
Addressing staffing challenges
In light of the recent staffing mandate, Rogers pointed out that less than 20% of all nursing homes meet the 24/7 staffing requirements for registered nurses (RNs) proposed in the current rule.
To tackle this issue, he shared Brickyard Healthcare’s approach. The company initiated a healthcare research project to bring in registered nurses (RNs) from the Philippines. Unfortunately, he said, this initiative was temporarily halted due to unhelpful moves by Congress, although he remains hopeful for a reversal by lawmakers to expedite the processing of visas for immigrant nurses.
“We hired over 100 RNs, mostly from the Philippines,” Rogers said. “And so we were very excited we got that started. And we had the unfortunate retrogression decision that prevented them from getting their embassy interviews and halted the process. But we’re looking, we’re hopeful that we can get that reverse potentially in October, and start getting those folks to come join our ranks.”
Scalo emphasized the critical nature of the RN requirement. While acknowledging that CMS is addressing staffing challenges, he expressed concerns that the new requirements may exacerbate the problem.
“It’s not even clear at this point whether you can use [RN] supervisors in that environment,” Scalo said. “The other other concern is that it’s going to be on a daily basis,” Scalo added, explaining that RNs are usually spread so thin due to a staffing shortage that facilities are incapable of providing an RN for a 24/7 presence currently.“So it’s important for all of us to get the Associations, to get the CMS’ attention.”
Scalo said it is important for operators to advocate for change. AHCA launched a campaign, sending 10,000 unique letters to CMS each month, and the group is also exploring legislative avenues to address the issue. He underlined the importance of consistently applying pressure on regulatory bodies to protect the industry’s interests.
“The cool thing about that is that CMS has to review [policies] every month,” he said. “So, we’ve been successful other times doing that. So I would urge you to go back to your facilities, and your companies should look at trying to get [staffing standards scaled] back.”
In the meantime, even before operators are forced to increase staffing levels to proposed levels, Hennessey said it was important to start by improving recruitment and retention by streamlining operations.
Hennessey highlighted the importance of taking administrative tasks off-site, such as social media postings, recruitment, interview scheduling, and billing, to allow on-site staff to focus on resident care.
“By really changing the way that we operate to be a community-centered model with our support services around it, we really changed the way the support goes to us,” she said.
She also emphasized the significance of flexibility in scheduling and adopting a community-centered model with support services tailored around it. She said these operational changes have not only improved HDG’s efficiency, but have also allowed staff to spend more time caring for residents.
Panelists also discussed other strategies for building and maintaining a sustainable workforce in the face of high turnover rates.
Scalo mentioned collaborations with nursing schools and community colleges, exploring partnerships with universities, and even in-house training programs as potential solutions.
Rogers emphasized the importance of culture and employee recognition in reducing turnover within the first six months of employment, with the aim to keep employees for at least up to five years.
“Our people are our greatest asset,” Rogers said. “The most important thing that we do is to recognize and give our people a sense of belonging in the work that they do and appreciate them.”
The impact of Medicare Advantage
The rise of Medicare Advantage was another significant topic of discussion.
All three panelists noted that the reduced payment rates and increased documentation requirements pose challenges, potentially leading to decreased lengths of stay and more denied payment requests.
“For Medicare Advantage, I think we’re seeing pressures in our own communities,” Hennessey said. “With length of stay, we call it even ‘the hassle factor’ of dealing with these organizations. I think it also changes the way that we look at Medicare database payment programs, because they’re now going to be a much smaller part of our revenue.”
Hennessey emphasized the need for advocacy and raising awareness about the consequences of these changes on communities and access to healthcare.
To counter the burdens of Medicare Advantage, Scalo noted the growth around the country of providers getting together in provider networks. This has been helpful because there is some value and quantity when dealing with Medicare Advantage programs, he said. And the other way operators are reducing the negative impact of Medicare Advantage is by some operators now becoming insurance companies.
“The biggest threat to us, I think, is going to be the expansion of Medicare Advantage, because for many of us, Medicare has made up the gap, we don’t get Medicaid. So I think it’s going to be increasingly a problem for us.”
The SNF of the future
As for where the industry is headed, Rogers said he sees specialization as a significant trend going forward, with some facilities focusing on short-term rehab and high acuity, while others catering to long-term care and chronic illness.
Meanwhile, Scalo said that the future of SNFs was driven by the expectations of the Baby Boomer generation, and operators should plan to include more private rooms and a home-like atmosphere.
“From that perspective, we’ve got to understand as providers that we are in a service business, it is their home, we’re in their home,” he said.
And, Hennessey emphasized the enduring role of SNFs in the healthcare continuum – and that operators should challenge their notion of which technology is appropriate for a skilled setting. For example, she said operators could increase using AI to ease up work that doesn’t necessarily need to be done by a human – like helping monitor for falls or assisting with scheduling organization.
“For me, as an operator, it will be a change of mindset,” she said. “And we’re all kind of set in our ways of what things we have to have a human do.” But this mentality has to change across the sector.
Companies featured in this article:
AHCA, Bartley Healthcare, Brickyard Healthcare, Health Dimensions Group
