Ministry systems join initiative to speed uptake of evidence-based medicine

By JULIE MINDA

Four large health systems with Catholic facilities are among the 42 organizations taking part in a new initiative aimed at more quickly using scientific research in health care practice.

The initiative is from the PatientCentered Outcomes Research Institute, an independent nonprofit organization authorized by Congress in 2010 to fund research that enables patients and clinicians to make better-informed health care decisions. The Health Systems Implementation Initiative the institute announced in March provides

Jerry Carley

From page 1 is going to go back into place. So all these rule waivers that were in place will cease to exist, essentially. For example, the threeday hospital rule that requires patients to spend three consecutive inpatient days in a hospital before they qualify for Medicare coverage of skilled nursing care, that’s coming back. But some of the requirements put in place during COVID are going away, too. One is the requirement for routine COVID-19 testing of residents and staff. That ends at the end of the public health emergency. funding to speed uptake of comparative clinical effectiveness research findings at health care facilities across the U.S. The institute initially is investing $50 million in the effort.

We’re still required to educate on and offer residents and staff the vaccine at least until May 21, 2024. Another continuing rule is that masks will still be required when there’s been a potential exposure. And then there’s also a requirement for reporting items related to COVID, such as the vaccination status of residents and staff. That’s going to go on forever, unless additional regulatory action is taken.

Is the new guidance appropriate and necessary in your opinion?

I think so. I think it’s a good start to getting back to normal.

Are there any particular state or federal policies that could be revised or added that would make it easier for Benedictine to serve its communities?

There’s no reason to bring back the three-day hospitalization rule. None. Medicare Advantage plans don’t use it. The only payment source that uses it is Medicare. We have gone three years without it, but now the waivers are going away and it’s going to come back again.

I’m also questioning a little bit the requirements for CNA certifications within four months of hiring. We’ve gone three years without it. (CMS) waived that so that nursing homes could get workers into the buildings. We still need to get workers into the buildings. But that waiver goes away at the end of the public health emergency.

How challenging has inflation and the push for higher wages been for Benedictine?

Minnesota since the pandemic has seen over 20 nursing homes close. Iowa has seen over 20 nursing homes close. What seems to be driving it is inflation, higher wages, use of agency staff and Medicaid and Medicare reimbursement methodologies that have not kept up with those rising costs. There has been this gradual closing of nursing homes for the last 20 to 25 years, but this has really accelerated it. And I don’t see an end in sight.

Benedictine has not had any closures. We’re not anticipating any closures as a result of this, primarily because we have a diverse portfolio with assisted living and independent living, which is not necessarily limited by Medicaid and Medicare reimbursements. They tend to be more private pay. The ones that are really struggling are the standalone skilled nursing facilities.

According to a press release on the initiative, the institute aims through the work to “cut the estimated 17-year lag between the publication of (research) results and their uptake in practice.”

The 42 participants in the Health Systems Implementation Initiative represent about 800 hospitals and 6,400 primary care locations across 41 states and the District of Columbia. Three CHA members —

Ascension, CommonSpirit Health and Mercy — are participating in the initiative. Intermountain Health, which has CHAmember facilities, also is taking part.

Participating health systems will collaborate, share information and establish best practices for implementing research learnings and for using metrics to gauge success.

The institute will provide funding ranging from $500,000 to $5 million per project to promote the providers’ use of specific evidence from institute-funded research studies. The institute has funded a wide variety of research, including on organ transplantation, weight management, bar- iatric surgery, mental illness, child abuse, heart failure, diabetes, Parkinson’s disease, cancer and obstetrics.

According to an institute blog post on the Health Systems Implementation Initiative, by conducting projects to implement evidence-based practices, “health systems will be leaders in refining, employing, and demonstrating workable strategies to improve care in real-world settings.”

The institute plans to scale up the Health Systems Implementation Initiative nationwide based on learnings from the initial 42 participating systems. jminda@chausa.org

Are you able to meet the demand for beds from patients who need skilled nursing care?

We are not able to meet the demand because we do not have the staff to care for them. What has happened during this latter part of the pandemic, specifically the last year or so when we had the great resignation, is a lot of nursing homes started to either limit or completely restrict admissions because they just simply didn’t have the nurses or certified nursing assistants to care for them. The nursing homes are sitting 75% occupied. There’s plenty of capacity, but the staff just aren’t there.

Until we take a stand at the state level or the national level to increase and help with reimbursement methodologies that can get us to become competitive again in the workforce, that problem is not going to solve itself.

What is the breakdown on reimbursement nursing homes get from Medicare, Medicaid and private pay?

Depending on where you’re at you could have care centers that are 70-80% Medicaid. In a couple of the states that we’re in, Minnesota and North Dakota, there’s rate equalization, which means that we can’t charge private pay more than what we get reimbursed from Medicaid. In other places, we can do that, so you can somewhat offset some of those costs by passing it on to the private pay.

There are still logjams in places with patients waiting to move from hospitals to long-term or rehabilitative care. Are you aware of efforts to address that?

We’re actually seeing a couple of hospital systems that have reached out to us that said, “If we help pay for staff to supplement whatever the costs are for the agency workers, can we create these arrangements and agreements?” We’re being innovative and creative on how we are working in partnership with hospitals to help decompress their bed availability, because they’re full. They need to discharge patients so they can admit people.

Has the staffing crisis eased since the height of the pandemic?

There’s all kinds of graphs out there that show that the nursing home industry is the only sector in the United States that has not recovered to pre-pandemic employment levels. Everybody else has recovered to some degree and maybe even is doing a little bit better.

There’s not the staff for us. I will hire you today to do whatever you want to do in one of our nursing homes. It’s that dire and there’s not a full understanding by our elected officials of how bad it is.

Is the nation ready to meet the needs of its aging population?

We can’t meet it today. There’s a fairly significant disconnect in what is happen- ing. It was reiterated again this week with the Biden administration talking about staffing mandates. They are saying, “If you don’t hit certain retention numbers, we’re going to reduce your Medicare reimbursement,” which just makes it worse. leisenhauer@chausa.org

Minnesota since the pandemic has seen over 20 nursing homes close. Iowa has seen over 20 nursing homes close. What seems to be driving it is inflation, higher wages, use of agency staff and Medicaid and Medicare reimbursement methodologies that have not kept up with those rising costs.

Developers are going to continue to build nice large private pay assisted living or independent living centers for those that can pay for it. But if we’re not going to get adequate reimbursement for Medicaid and Medicare, we’re not going to see that side of the equation be developed.

We at Benedictine have zero plans for building any new nursing homes because the financial modeling doesn’t work in its current environment, which is a challenge because that’s part of our mission.

Are the needs and desires of people coming into long-term care today different from those in the past and, if so, is Benedictine adjusting its services or policies?

The needs and desires are much different. I’ve been doing this for over 30 years. When I got in this business, a lot of the nursing home residents then would be assisted living residents today. That’s where there’s been a shift.

We’re moving much more heavily into assisted living and independent living, moving away from skilled nursing facilities. We’re not going to fully move away from skilled nursing facilities because there’s still a need there. But that need is so much less today versus 30 years ago because of the assisted and independent living options.

A lot of eldercare providers are getting away from nursing homes just simply because of the regulatory environment and the punitive nature of that particular space. I think we’re going to continue to see that shift going forward.