Transitional Care Management Director of Clinical Reimbursement Sabrina McCarley, MBA-SL, OTR/L, CLIPP, RAC-CT, QCP, FAOTA, offers her expertise in the following article from McKnight's Long-Term Care News.
Audits of skilled nursing providers are likely to increase this year, with a growing number of federal and state recovery audits adding to specialized compliance reviews announced last year.
In 2023, regulators instituted audits of facilities using potentially inappropriate diagnoses of schizophrenia, as well as a new, five-claim audit of every US nursing home that was specifically meant to root out improper payments.
Now, routine audits run by the federal Medicare Fee for Service Recovery Audit Program and states looking to ensure payment accuracy through the Medicaid program are roaring back to life.
“While RAC audits practically halted during the COVID-19 pandemic, activity has picked up substantially following the end of the public health emergency,” attorney Amy Fouts wrote in BakerHostetler’s Healthcare Industry 2023 Year in Review published Thursday.
While some of the Recovery Audit Contractor activity is moving toward outpatient services, she warned inpatient providers such as skilled nursing operators to stay vigilant for more scrutiny.
So, too, does Sabrena McCarley, director of clinical Reimbursement for Transitional Care Management.
While she won’t go so far as to call any 2023 increases in RAC activity an “explosion,” she said her company and others who provide billing and compliance support to nursing homes are seeing “an increase in audits of everything.”
“The floodgates, essentially, have opened,” said McCarley, secretary of the National Association of Rehabilitation Providers and Agencies. “When you just talk about the RAC audit, people think, ‘Oh I’m totally excepted. I don’t take Medicare. I’m never going to see an audit.’ … They kind of get in this trap. They’re in a bubble, and then they don’t know what to do when their bubble bursts.”
Transitional Care Management’s new Administrator in Training program (AIT) provides hands-on, specialized learning and mentoring opportunities.
The nine 2023/2024 participants were invited to expand their horizons (and their career options) with Transitional Care University’s inaugural four-module, 460-hour administrative learning opportunity.
They will gain practical career-advancing knowledge and experience in Long-Term Care, Skilled Nursing, Memory Care, and Behavioral Health.
Transitional Care University AIT grads earn:
Supplemental, fast-track specialized training that is an ideal “next step” for professionals on an administrative career path
A certificate of course completion
Skills to further enhance career progression
Administrator in Training title
Opportunity for growth within the organization.
In addition, this program meets supplemental criteria for LNHA exam (dependent on individual licensure criteria) and helps prepare candidates to take licensure exams.
The program will run annually with next class starting Fall of 2024. Talk to your administrator or contact Contact Terri Galloway, Director of Talent Acquisition, at TGalloway@tc-mgmt.com for more information.
Transitional Care-managed communities are setting new industry standards!
Terrace Care communities’ new Life Sills program, which features 10 key modules for teaching key skill sets for building competencies in daily routines that are needed to live more independently, earned the 2023National Association of Rehab Providers and Agencies (NARA) Impact Award.“The purpose of the NARA Impact Award is to recognize excellence in the creation of a program that demonstrates a positive clinical impact, exemplifies a new dimension of performance, and can be easily replicated or adapted,” says Linda Riccio, OT/L, Vice President of Therapy Services (pictured left). “Our new Life Skills program does exactly that!”
Linda collaborated with a team of Terrace Care and Transitional Care experts, including Michelle Stuercke, Chief Clinical Officer and Najat Williams and Yomi Adebogun, Behavioral Program Specialists, to develop and launch the program.
“The Terrace Care Life Skills program is a market differentiator for our communities,” says Charles Ross, Chief Strategy Officer. “It helps us improve census, impress referral sources, reduce re-hospitalization, and improve length of stay.”Denise Norman, President of Transitional Care Management (pictured lower left) adds,“Most importantly, our award-winning Life Skills program offers staff, residents, and guests a new toolbox of resources to help them better meet mental health and discharge preparation needs. It is a WIN/WIN for all!”
Join Linda Riccio, Vice President of Therapy Services with TransitionalCare Management, for a Zoom presentation identifying the key differences between compassion fatigue, burnout, secondary trauma, and PTSD. You will learn evidence-based tools used to assess compassion fatigue and well-being. Linda will encourage you to voice three self-care strategies you will use to minimize burnout and promote your resilience.
September 14th, 2023, 12:00 pm- 1 pm. $35
Illinois Pioneer Coalition members are eligible for one free CEU.
By Alex Spanko |
Developing new post-acute and long-term care infrastructure during normal times isn’t always easy — in fact, for one Illinois company, the phased opening of three new skilled nursing facilities this year represented the culmination of more than five years of work.
But as COVID-19 continues to reveal the fatal shortcomings of outdated nursing home design, calls for newer facilities with private rooms and a higher level of care have already grown louder, and the team at Innovative Health believes they’ve made the right bet on what seniors and hospital partners will want in a post-pandemic world.
“Time will tell our success, but I think the model is so different that people are really willing to give us an opportunity to show them how different it is,” Innovative Health chief strategy officer Charles Ross told SNN.
The company is two-thirds of the way through opening a trio of new skilled nursing facilities in the western Chicago suburbs of Mundelein, Lisle, and Aurora, Ill., all branded under the Thrive name. The former two are currently open and operational, with the third set to open later this year.
The Mundelein project, Thrive of Lake County, replaced a county-run facility that Innovative Health initially applied to take over on an interim basis around six years ago. The other two, Thrive of Lisle and Thrive of Fox Valley, represent completely new developments, with a total price tag of about $80 million for all three.
Thrive of Lake County’s status as a replacement for an existing nursing home helped to ease the project through Illinois’s certificate of need (CON) process; like many other states, Illinois limits the number of skilled nursing beds that can legally operate in an attempt to prevent oversaturation and, in theory, maintain a high standard of quality.
In this case, the new facility clocks in at 185 beds, compared to the old property’s 224.
“Essentially, we were de-bedding the market by 39 beds, so the CON board obviously understood what we were trying to accomplish,” Innovative Health principal owner Brad Haber said.
That doesn’t mean the road was easy: Even with that advantage, it took the the Innovative Health team a year to secure the CON approval on the replacement building, while facing challenges on the CONs for the remaining two facilities.
The Lisle facility also saw delays with receiving formal certification for Medicare and Medicaid residents from the state of Illinois, despite serving residents covered under private insurance plans, according to Brian Cloch, principal of Innovative Health partner Transitional Care Management.
Thrive’s experience is indicative of the inherent challenges in designing and building new skilled nursing inventory in many markets. Aside from CON rules, which often do not allow the creation of new nursing home beds without contraction somewhere else, investors aren’t always willing to place a bet on new construction in a space perceived as particularly susceptible to abrupt changes in government reimbursements.
Some companies have seen preliminary success with the high-end “medical resort” model, with real estate investment trusts (REITs) and other investors putting up tens of millions to construct luxurious properties that cater to younger seniors who want a hotel-like experience while recovering from surgeries and other acute events.
But on the whole, investment in new nursing homes has been limited, contributing to a landscape where operators in the space generally have the oldest physical plants in the greater senior care spectrum. The average nursing home still features shared rooms and narrow corridors that consumers and their families don’t prefer — and which serve as particularly virulent breeding grounds for COVID-19.
In Massachusetts, for instance, state health officials have noted that rules requiring new nursing facilities to have single-occupancy rooms have been on the books since the early 2000s — but because so many older facilities were grandfathered in through waivers, a lack of substantial new construction means that the state still has a primarily old stock of nursing home real estate.
The pandemic has thus brought nursing home design into the greater public consciousness, with the Green House model of small-home design emerging as a particular area of focus for big-picture thinkers in long-term care.
But Thrive’s strategy of lower bed counts and ground-up design could also position the buildings for life amid a pandemic with no end in sight.
“What makes us different is that we have made the commitment to the design of the building and to the care delivery model,” Cloch said.
The Thrive buildings have all the trappings of the higher-end medical resorts that have spurred investor excitement, such as a kitchen with a professional pizza oven and lobbies that look more like boutique hotels than nursing homes.
But the luxury design touches belie a wider strategy. The Mundelein campus, for instance, features three separate buildings for each of its main care models — short-term rehab, long-term care, and skilled memory care — connected in the center by a shared kitchen. Each of the buildings has its own separate entrance, dining area, therapy gym, and other amenities, according to Cloch.
Unlike some other new developments, the Thrive facility in Mundelein also accepts Medicaid, allowing residents to remain at the facility long-term if they end up needing more than the 100 days of Medicare-covered post-acute care, Cloch noted.
The other two properties, which will both feature 60 beds and serve only post-acute residents, were designed with the potential for reconfiguration in mind, Ross aid.
“The way the different centers are designed if we should ever need to separate suites because of COVID or clinical programming or really any other reason … we’ve got multiple units that can be closed off and work independently from each other,” Ross said. “So it gives us a lot of flexibility.”
The Thrive team has focused on showing the buildings’ worth to hospital partners, which have been forced to reconsider their own post-acute strategies amid a sharp drop in elective surgeries and patient concern about going to an institutional setting after witnessing tens of thousands of COVID-19 deaths in American nursing homes.
While Ross acknowledged that health systems in Thrive’s markets have accelerated their push to send more people directly home, he noted that they still recognize the need for institutional care for some portion of the population — and that providing something different, with private rooms and bathroom facilities, can help set operators apart.
“They’re still finding there’s a core population that just isn’t going to do well at home, and it’s going to need transitional care, and need our products,” Ross said.
READ ORIGINALLY PUBLISHED STORY HERE
By Lyndee Yamshon |
Despite a general lack of new construction in the skilled nursing space, one owner/operator stands out for building three brand-new skilled nursing facilities in the Chicagoland area.
And when many companies are paring down staff and consolidating, Brad Haber, principal owner and operator at Innovative Health, LLC, is midway through spearheading three SNF construction projects in Mundelein, Lisle, and Aurora for about $80 million in total.
Innovative Health, a short-term transitional and post-acute health care company based in Northbrook, Ill., will replace Winchester House and bring existing staff to the new Mundelein facility and a new set of staffers to the Lisle and Aurora buildings — adding 200 employees, concentrated mostly in nurses with at least 15 new therapists.
Transitional care facilities move ahead in Lisle, Aurora
Rosemont-based Innovative Health said Monday it will break ground this summer on new short-term rehab centers in Lisle and Aurora, after winning court decisions against local competitors attempting to stop them.
Innovative Health, which also plans to build more facilities in the region, already acquired the land on Ogden Avenue in Lisle and on New York Avenue in Aurora for about $1 million each. The company plans to spend another $40 million to construct the two 68-bed facilities, which will add about 200 jobs by next year.
"We're very confident that we'll fill these facilities after we did the research prior to picking the locations," said Brad Haber, principal and co-founder of Innovative Health. "These areas demonstrate a need with a lot of growth expected."
The state approved both projects last May, and zoning permits were provided by Lisle and Aurora officials. Read More
Aging baby boomers are transforming the conventional nursing home.
The stigma attached to nursing homes most often is that they're a place you go to die. The last thing baby boomers, who came of age in the '60s and '70s and practically invented youth culture, will ever admit is that they are getting old.
"We feel that baby boomers as consumers want this," said Denise Norman, president of Transitional Care Management, which opened the Arlington Heights facility in September. "You've got all the medical needs, the nursing, the therapy. People expect that, but then if you can add that component of comfort, a little bit of luxury, they'll feel better faster."
What sets Transitional Care apart is more than aesthetics. Like its name suggests, Transitional Care specializes in caring for people after they've been released from hospitals but aren't ready to go home. Unlike most nursing homes, it's not in the business of long-term care.
The company, based in west suburban Lisle, is growing. Earlier this month state health care regulators approved Transitional Care's proposals for new facilities in Lisle and Aurora.
Transitional Care is taking advantage of changing demographics. As Americans age, demand for short-term rehabilitation, also known as post-acute care, will increase. By 2040, the number of people 65 years or older will double to 82.3 million, or about one-fifth of the U.S. population.
Seismic shifts in health care economics also are forcing physicians and hospitals to work more closely with providers of post-acute care to make sure patients don't return to the hospital.
The forces reshaping the nursing home industry are giving consumers more choice. But the investment in facilities dedicated to short-term rehab has been slow to come to Illinois because of regulatory hurdles and opposition from within the nursing home industry.
Nursing homes typically take care of two very different kinds of patients: (Read More)