News

Back in September, I shared my insights in McKnight’s Long-Term Care News about the importance of being your own data defender. In that blog, I expressed a viewpoint that I believe strongly in: Every nursing home should consider appointing a “data czar.”

This strategic move positions the facility to excel in representing itself to external stakeholders and, crucially, defending against potential reputational challenges.

Since that writing, my conviction in the concept of appointing a data czar has only grown stronger. Several recent experiences have concretely shown how a dedicated individual in this role can make a substantial difference. These experiences allowed me a more comprehensive understanding of a data czar’s role in ensuring data integrity and contextualizing the data to uphold the reputation of their nursing home. I’ll talk about one of them here.

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In May 2023—after the Comprehensive Error Rate Testing (CERT) program determined that skilled nursing facility (SNF) Medicare Part A services have been “a top driver” of the overall Medicare fee-for-service improper payment rate since the

It’s been a flurry of activity leading up to the implementation of the “new MDS.” For months our industry has been doing what we do best — rising to the occasion.

Countless MDS training sessions, manuals, tip cards and software updates have filled our inboxes and daily industry news. However, if the arbiter of success isn’t making it past the Oct. 1 start date, then what is?

With this in mind, I turned to some of the best and brightest at Zimmet Healthcare: Alicia Cantinieri, Melanie Tribe-Scott and Amy Greer. In total, the three of them have completed dozens of public and private training sessions on the new MDS. But what I wanted to learn from them were any early warning signs that the transition wasn’t going well. Their response made me sound the alarm: “Fasten your seatbelts: It MIGHT be a bumpy ride.” However, they also offered several sage tips that should help you avoid unnecessary potholes.

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In a LinkedIn post Tuesday, reimbursement expert Marc Zimmet cautioned providers against that “better” standard.

“Operators anticipate significant rate increases per pre-transition modeling, but without additional funds, we  end up exactly where we were under the old system,” the Zimmet Healthcare Services Group president and CEO wrote. “Invariably, the same operators with high scores in one system have the highest scores in the new one because CMI is often as much about reimbursement management as it is patient acuity.”

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“Well, it’s clear that you’ve never set foot into a nursing home.”

I know you’ve thought that while reading a memo from the Centers for Medicare & Medicaid Services or your state agency, taking in a newspaper or TV report, listening to a politician speak, or even looking through your own policy and procedure manual.

And I know you’ve thought that more than once. I certainly have during my career. Sadly, the person “laying down the truth,” the person who makes your eyes roll or blood boil, is often the one coming from a position of power.

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Although survey citation rules can vary from state to state, nursing home operators can implement broad steps to avoid deficiencies if they focus on the often overlooked easy fixes as well as the more complicated overlaps between disparate areas of care – ranging from food safety and mental health documentation to infection control.

Certain trends persist across the board, and to successfully issue a plan of correction for a survey deficiency, operators may need to take a multidisciplinary approach, according to Amy Greer and Alicia Cantinieri of Zimmet Healthcare Services Group (ZHSG).

Simple solutions in infection control, which remains a significant concern even in the post-Covid era, involve keeping in place stringent infection prevention protocols. Meanwhile, another relatively undemanding area to keep up with is food safety and procurement, but it often gets overlooked.

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For skilled nursing facility operators, the most common survey deficiencies might not be the ones always at the top-of-mind.

In multiple states, a Zimmet Healthcare Services Group (ZHSG) analysis found that food safety and procurement was the primary deficiency, among other areas, like basic infection control and resident rights.

“During interviews, the food quality often emerges as a complaint. However, it’s also about proper kitchen practices,” Amy Greer, Clinical Consultant, Quality Initiatives at ZHSG, said in a panel discussion at the firm’s recent “Roaring Reimbursement” conference in Connecticut. “Hazards, labeling, temperature control, and adherence to food safety guidelines matter.”

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With a substantial amount of reimbursement being at stake, the effect of the change from the PHQ-9 to the PHQ-2 to 9 is the “million-dollar question” facing operators, Alicia Cantinieri, vice president of MDS policy and education for Zimmet Healthcare Services Group, said at the firm’s recent “Roaring Reimbursement” conference in Connecticut.

While the exact consequences of the PHQ switch remain to be seen, the new interview parameters are going to “change things pretty drastically,” Ignite Medical Resorts VP of Clinical Reimbursement Shawna Rainey told Skilled Nursing News at the Zimmet conference.

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A broader public data pool that captures practices of individual nursing homes and patterns across portfolios is being used out of context and further complicating the legal landscape for operators, experts warned as two data-fueled class action lawsuits head toward trial in Kentucky.

The lawsuits allege business owner Terry Forcht and companies that manage two of his nursing homes violated laws that require sufficient nurse staffing levels. Patients and former patients are seeking reimbursement for “services not provided.” To build the cases, a firm representing the plaintiffs has said it used Medicare cost report data alongside expanded Payroll Based Journal data available through Care Compare to measure sufficiency.

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Not content to chisel only taxpayers, Medicare Advantage gluttony is also occurring at the expense of beneficiaries in nursing homes and their providers alike.  Marc Zimmet, president of Zimmet Healthcare Services Group, has created a dynamic “debt clock” calculating the losses from Medicare Advantage across the skilled nursing sector and broken out to the average facility.  This year’s aggregate loss will easily exceed the cost of the $11.3 billion staffing mandate scenario.

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