A worrisome slowdown in federal distribution of coronavirus rapid-screening tests this week is only a temporary aberration that will quickly be corrected, the leader of the largest skilled nursing and assisted living association in the country assured Wednesday.
High-ranking officials at the Department of Health and Human Services said there was a downturn in production of the Abbott BinaxNOW that caused delays, but regular delivery of 1 million tests per week should resume again next week.
Mark Parkinson, the president and CEO of the American Health Care Association / National Center for Assisted Living, gave the new update based on fresh information during an exclusive, wide-ranging interview with McKnight’s Long-Term Care News on Wednesday. He said that he received regulators’ reassurances earlier that morning after some providers had reported not receiving their allotments.
The tests help providers meet new federal requirements to test staff twice a week if they are in “red” counties that have the highest COVID-19 infections rates, once a week in lesser-infected “yellow” counties and once a month in least-infected (“green”) counties.
The stakes are high because the government’s decision to send the devices to various nursing homes and assisted living operators has been “a game-changer,” Parkinson said
“They’re free and we’re getting very rapid, and apparently very accurate, results,” he said. “So the question on testing and its cost is completely linked to the government’s ability to send out these tests.”
He said that a well-placed staff member for HHS Assistant Secretary Adm. Brett Giroir confirmed that test units will continue to flow to skilled facilities in red and yellow counties, as well as assisted living buildings that have the appropriate federal CLIA waiver.
“As long as they continue to do that, we can comply with the testing requirement and financially be OK,” Parkinson said. “Once they stop sending those tests, we have a real problem. Their commitment at this point is to send them through at least the end of the year. It doesn’t completely satisfy the testing requirement, but it’s extremely helpful.”
Declining infection positivity rates, meaning fewer mandated tests overall, has helped the outlook, the AHCA top exec noted.
Heads in beds
The industry’s biggest business worry currently is facilities’ low census levels, which are down by double-digit percentage points across the board; they might not turn around until the second quarter of 2021, Parkinson said.
“We have really good weekly data [through the Centers for Disease Control and Prevention’s NHSN portal] and unfortunately they show occupancy plummeted 10% shortly into the pandemic and it hasn’t gotten better,” he noted. “The numbers [analysts] should be looking at every week are occupancy data.”
“We can get lots and lots of CARES Act money for providers, but if census doesn’t recover, there’s just not enough money to get,” he added. “The numbers just don’t add up.”
Parkinson said, however, that if providers can hold out until a coronavirus vaccine is widely distributed, census will ultimately return due to favorable demographic trends and the fact that long-term care remains a needs-based industry. To get that far, another federal stimulus package is needed, he believes. While he is hopeful that still might be accomplished before the Nov. 3 elections, he believes that providers can “make it” as long as more relief arrives by the end of the year.
For some providers, such as beleaguered post-acute giant Genesis HealthCare, relief can’t come fast enough. Genesis CEO George Hager has publicly doubted that the company can continue operations under current conditions without more relief.
Parkinson believes two decisions by the Centers for Medicare & Medicaid Services over the past week will give Genesis, and other providers hard hit by the coronavirus, particularly in the Northeast, a boost. The first postpones repayment obligations for emergency Medicare advance payments until March 2021.
“That’s a major cash-flow issue for all providers, but it’s a real lifeline for providers who got hit early on,” Parkinson noted.
The other decision extends until Jan. 22, 2021, the public health emergency, which produced a much-hailed three-day hospital stay waiver for Medicare SNF eligibility.
“I’m concerned about Genesis and all of the folks that were hit hard early on,” Parkinson said. “But I’m optimistic that with some of those decision made recently, they’re going to make it to the vaccine. And then it comes to how long will it take for census to return. I’m actually a little more bullish on Genesis than I would have been a month ago because of some of the announcements that have occurred.”
Less construction, more trust needed
Parkinson said that long-term care will benefit from the confluence of increased demand and decreased supply. The latter is partly due to depressed construction of new nursing homes in the near future.
“Eventually, it will be OK, but some people can’t wait until eventually. They need recovery very quickly,” he observed. ” I’m not sure how long it will take — I don’t know if anyone does.”
The sector as a whole needs to convince the public that long-term care facilities are safe places for their parents, he added.
“Individual companies can accelerate that through their own marketing efforts. But the public is going to need to be convinced,” the former facility owner explained.
He pointed to PruittHealth’s recent announcement that it would be putting a full-time infection control preventionist in each of its buildings as one innovation that could make a difference.
“It’s not required, but they’re going to do it because it’s the right thing to do,” Parkinson said. “I think companies that do things like that will see a faster recovery in census.”