The coronavirus pandemic is taking center court in our professional lives lately.
But believe it or not, there will soon come a day when other matters will start demanding attention. You know, little things like regulatory oversight, payment challenges and remaining solvent.
Speaking of all three, did you happen to catch the April story in Health Affairs that compares Medicare Advantage to the government’s fee-for-service alternative? The piece serves up two money-saving options for the future:
1) Shift more higher-acuity, post-acute patients from rehab centers to skilled care settings.
2) Shift more lower-acuity, post-acute patients from skilled care facilities to home- and community-based settings.
My opinion on the report and $1 will get you a large Diet Coke at the nearest McDonald’s drive-through. Still, here’s my take:
This isn’t just another report of the file-and-forget variety. It’s more like a sneak preview of what your caseload will look like. Two explanations for this looming reality come immediately to mind. One is the federal government. Another is insurance companies.
As it happens, the former is running out of money. Or at least the kind of money that’s been set aside to pay for Medicare-covered healthcare.
The latter is playing a bigger role in all things Medicare. And here’s a big reveal: Insurers generally don’t like to pay a penny more than is absolutely necessary.
What this means for operators who plan to remain in the Medicare program is this: You will soon be swimming upstream in a big way.
The “easy” cases — resident transfers who are less difficult to manage — are going to become increasingly rare. That’s because so many of them will be going straight home, or to another post-acute setting where costs are considered lower. Those coming your way will be stable but still medically complex.
Put another way, your facility is probably going to look an awful lot like a hospital without an operating room — if it doesn’t already.
So much for getting back to business as usual.
