Healthcare News of Note: Most nursing facilities are short staffed under CMS’s proposed long-term care rule, says KFF

• Based on August 2023 data, only 19% of long-term care facilities would meet the new requirements of CMS’s proposed rule, which means most (81%) facilities would have to hire additional RNs and nurse aides within two years.
• Achieving fair, equitable and transparent coverage and payment for digital medicine services remains a challenge, with certain issues in the commercial payer space affecting the widespread adoption and accessibility of digital medicine services for both patients and physicians.
• WebMD honors 167 health systems in its 2023-2024 Choice Awards.

Over the past few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals.

1. CMS’s proposed rule puts nursing facilities in a tough spot

Fewer than 1 in 5 nursing facilities would meet hours-per-resident-per-day (HPRD) provisions outlined in CMS’s new proposed rule for long-term care facilities, which would require most to hire additional RNs and aides in a time when finding skilled workers is a challenge, according to a KFF issue brief, published Sept. 18.

Although the brief analyzes the percentage and characteristics of facilities that would meet the new requirements for nurse staffing levels in nursing facilities, it does not evaluate facilities’ abilities to comply with other requirements, such as having a registered nurse on duty 24/7, wrote the brief authors.

Key findings

Additional takeaways, according to the brief, include:

• 81% of facilities would have to hire additional RNs and nurse aides, which means only 19% of facilities now would meet the new requirements.
• Of the current facilities, 52% would meet the RN requirements while only 28% would meet the need for additional nurse aides.
• Most for-profit facilities (90%) would need to hire additional nursing staff, compared with 60% of nonprofit and government facilities.

AHA input on the proposed rule

On Sept. 1, the American Hospital Association (AHA) released a statement about the proposed rule stating, in part: “The AHA strongly believes that a skilled, caring workforce is integral to delivery of high quality, safe care. At the same time, safe staffing is about much more than a number. It is a highly dynamic process requiring flexibility and clinical judgment that accounts for patient needs, facility characteristics and the experience and expertise of the care team.”

The statement included some concerns about the rule, including:

• The idea of having a “one-size-fits-all numerical staffing threshold,” which removes the role of clinical judgment in staffing facilities and inadvertently creates issues for patients needing access to such care
• The expectation that implementing a numerical staffing threshold in two years could actually resolve healthcare workforce shortages that have been “building for more than a decade”
• The feasibility of finding enough skilled workers to fill the gap in workers that occurred during the pandemic has been the challenge

The statement went on to commend the Biden Administration’s plans to invest in education for healthcare staff and noted it “looks forward to working with CMS to advance solutions to bolster the health care workforce and deliver high-quality, safe care across the health care continuum.”

HFMA insight

• Read “Healthcare News of Note: Unlocking new revenue streams is the healthcare industry’s top priority, while workforce issues are its top risk” published Sept. 8.
• Listen to the Voices in Healthcare Finance podcast’s April 17 episode, “Sleepless in the C-Suite, Part 2,” which focuses on ways clinical workers need support from their leaders.
• Read “Ken Perez: U.S. demographic realities and the productivity mandate for healthcare,” published May 26, 2022.

2. Fair, equitable and transparent coverage and payment of digital medicine services remains a challenge

Both physicians and consumers find it difficult to traverse the digital medicine landscape due to “a lack of alignment across commercial, Medicare and Medicaid plans regarding coverage of digital medicine CPT codes,” according to research published Sept. 18 by The American Medical Association (AMA).

The authors wrote: “Achieving fair, equitable and transparent coverage and payment of digital medicine services remains a challenge. These issues ultimately affect the widespread adoption and accessibility of digital medicine services for both patients and physicians.”

Key themes

Additional key themes from “a detailed comparison of digital medicine code coverage across 16 commercial payers” include:

• Inconsistent adoption of new digital medicine CPT codes within the commercial market
• Highly variable levels of transparency regarding coverage of digital medicine services across commercial health plans
• Varying processes and timelines for adopting new CPT codes across health plans
• Limited widespread utilization of most new digital health CPT codes

“The primary goal of this research is to provide a comprehensive understanding of the coverage landscape for digital medicine codes by commercial payers, shedding light on which services are funded and identifying untapped opportunities to bolster digitally enabled care,” the authors wrote.

JAMA study shows digital coaching sessions peak time

Additionally, a JAMA Network Open study, published Sept. 13, noted digital “coaching sessions peaked in the evenings” for a digital “platform called Lark that offers chronic disease prevention and management programs covered by members’ insurance,” with 35.2% of sessions occurring during business hours and 64.8% after hours.  

Other findings

The authors also noted the following findings:

The business/after-hours split differed by age, with adults aged 50 to 64 engaged the most after hours (65.4% of sessions), while adults aged 18 to 34 engaged to a lesser extent (62.1% of sessions).

• The business/after-hours split did not differ by sex
• Mean (SE) session duration was 4.78 minutes, differing somewhat by age and sex

3. 167 U.S. health systems receive a WebMD Choice Award

WebMD announced the recipients of the 2023-2024 WebMD Choice Awards, honoring 167 health systems, according to a Sept. 18 news release.

“The WebMD Patient Choice Awards and Medscape Provider Choice Awards are granted to health systems within the top 30% of patient or provider preferences in a local market, respectively,” the release states. “Health systems that rank in the top 30% of both patient and provider preferences and receive twice the percentage points of their next ranking competitor, are honored with the WebMD Elite Choice Award.”

Twenty-six health systems earned the elite designation.

This annual program ranks health systems in five specialties (cardiology, gastroenterology, neurology, oncology and orthopedics) and 44 treatments/procedures across 28 markets and 112 subregions.

“The Choice Awards are unique in our industry and are the only ones to provide the much-needed perspectives of both patients and providers,” said John Whyte, MD, chief medical officer of WebMD, in the release.

HFMA bonus content

Check out HFMA’s Cost Effectiveness of Health Report, September 2023, curated by Eric C. Reese, PhD, writer and editor.

Read “CMS pressures states to restore Medicaid coverage for some beneficiaries who have been disenrolled” by Nick Hut, senior editor, published Sept. 25.