Nursing home operators, as always, are juggling many moving parts to stay ahead, but some initiatives are taking precedence this year – particularly stabilizing the workforce via career ladders, policy changes tied to Medicaid and managing technology.
Executives are discussing policy and reimbursement hurdles, with the One Big Beautiful Bill Act (OBBBA) spurring talks with states about retroactive Medicaid approvals. The latest federal decision to drop retroactive approval from 90 to 30 days is causing concern, Deke Cateau, CEO for Georgia nonprofit A.G. Rhodes, told Skilled Nursing News.
“No one gets approved in 30 days, that just does not happen at all,” said Cateau. “Going from 90 to 30 days is dramatic, and it’s one thing I have my eyes on more closely.”
Other operators like Tennessee-based Diversicare have added new government relations roles to address policy changes, including retroactive approvals, according to Diversicare COO Becky Bodie.
And all the while, operators are tasked with unlocking time and cost savings linked to AI. Such tools are powerful ways to give staff more time caring for residents at the bedside. However, pioneering AI in health care is grounds for a healthy amount of wariness too, they said.
Stabilizing SNF leadership
Operators are working on stabilizing leadership, with Diversicare focused on creating career ladders for the Director of Nursing Services (DNS) role, similar to administrators in training programs.
In addition to leadership positions, Diversicare offers paths for certified nurse aides to become medication technicians, or “med techs.” From there, some eventually take on roles as a licensed practical nurse (LPN) and registered nurse (RN).
“We believe that that’s going to be the secret to continuing to stabilize our leadership,” said Bodie.
Texas-based Focused Post-Acute Care Partners is modeling their career ladder after what hospitals do, CEO Lori Strubbe said, asking their nurses to “level up” this month. Nurses put together a packet of sorts on why they should be considered for a higher position and these packages are reviewed by corporate leaders.
“We’re pretty excited to see how that goes. It’s been well received so far by our nurses and so we’ll keep you posted on that,” said Strubbe.
Meanwhile, labor costs have “gotten out of our hands,” Cateau said, because of inflation. I think we all are going to struggle with that,” he said.
Deep potential issues with Medicaid
Cateau touched on the reimbursement environment as well, especially the Medicaid program. While Georgia isn’t a Medicaid expansion state and provider taxes won’t be an issue this year, any changes to the Medicaid system will have “deep potential issues,” he said, referring to the OBBBA.
“Medicare doesn’t work without Medicaid. A lot of things don’t work without Medicaid, and it is such a high percentage of what we do,” said Cateau.
Medicaid retroactive approval, for one, is going from 90 days to 30 days, a change that has tremendous potential to affect nursing homes and their residents. Medicaid retroactive coverage is when medical bills are incurred before application for the program, and there’s a window to get coverage after a medical event.
The Medicaid application process is very different in every state, Bodie added, just like reimbursement rates. In Mississippi, for example, the resident’s family must do the Medicaid application; staff are forced to rely on the family to follow through with the paperwork for coverage.
With the federal budget passed, Cateau now says operators need to work with their respective states to figure out and sort accommodations when it comes to retroactive approval, among other changes ushered in by OBBBA.
Thankfully, Georgia has had a governor and legislature that has been on “the right side” of the Medicaid debate, and so Cateau is hopeful that operators will be able to work with the state on these problematic retroactive approvals.
For Diversicare, the changes pushed by OBBBA have resulted in a dedicated government relations team member to be on top of all these changes to Medicaid and beyond, and exert influence when needed.
AI excitement, and wariness
Diversicare has implemented several AI processes in clinical areas, looking at real time data to help staff make better decisions and reduce re-hospitalizations as well as improve accuracy of MDS submissions.
The team is looking at another service that helps nurses problem solve by scrubbing documentation, while another would speed up cash management and authorizations.
“Anything manual that we are doing today, we are looking for an AI solution. There are processes out there that look at [referral] data and make a decision within seconds,” said Bodie. “We are open and looking for anything that can reasonably replace a manual process and speed it up to make it more efficient for our team members.”
A.G. Rhodes is getting good results from AI admission software, Cateau said, along with software dedicated to falls and rehospitalizations.
“It’s a lot of predictive analysis around patient changes. We’re working with a neat one now, an activities AI portal that is designed to give the activities directors more hands with the residents and less time working on calendars,” said Cateau.
But leaders in the sector are balancing excitement for these pioneering tools with a healthy amount of wariness, with government entities also bringing on their own AI tools for predictive analysis and to monitor for overbilling and overcoding, Cateau said.
It’s a good idea for operators to have a corporate policy guideline in place around AI and how staff plans to use it, Bodie added, especially from a HIPAA perspective.
And while AI is a powerful cost saving and time saving tool, it doesn’t replace human critical thinking that is “necessary in our world,” Strubbe said, or the compassionate care that is at the core of what nursing home staff does.
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