Dr. Shari Ling, Deputy Chief Medical Officer for the Centers for Medicare and Medicaid Services (CMS) on Thursday confirmed that the agency will release a proposed minimum staffing standard for nursing homes this spring, and said that CMS is taking the comments and the data on staffing very seriously.
“CMS is working on and has fielded a staffing study and also put out a request for other sources of information to help us shape what staffing requirements look like,” Ling told Skilled Nursing News at the publication’s CLINICAL conference in Washington, D.C. “We all will look forward to when we’re able to publicly release and speak to some of the details.”
Ling appeared at the event a few days after President Joe Biden’s recent executive order elicited frustration from operators and advocates, some of whom said that without funding, well-meaning directives will only compound the staffing crisis and do little to improve the quality of care. The order called for the Department of Health and Human Services (HHS) to consider tying Medicare payments to nursing home staff turnover rates.
Yet Ling said directives are about providing high quality care to Medicare beneficiaries regardless of where they may intersect or interact with the health care system. And she stressed that creative thinking and operational innovation will be needed to meet this goal.
“Staffing has been an overarching challenge for our health care system, across the board,” she said. “And it’s not just in health care, it’s in other sectors, in other areas where we have had to be creative. And in that, necessity is the mother of invention.”
Ling urged nursing home providers to communicate with CMS about innovations or ideas for creative approaches that could help address the staffing crunch, and flagged that an entire day of the upcoming CMS Quality Conference will be focused on nursing home care.
“This is an opportunity, as well as a challenge,” she said, of the upheaval around staffing.
Solutions for the future
One example of creative thinking involves revitalizing the teaching nursing home, Ling said.
“There’s a Pennsylvania study that’s been funded by the John Hartford Foundation and others … bringing students into nursing home care in a way that there’s live, on the ground teaching, and enticing students to enter this sector of care,” she said.
Even beyond staffing, the future for nursing homes is being shaped by shifts in health care delivery and payment, and patient profiles.
The Covid-19 pandemic demonstrated just how crucial nursing homes are within the overall continuum of care, and they need to be more integrated into the health care system in regard to discussions about policy and planning, she added.
“How do we improve the throughput when people do need unscheduled acute care?” she said. “The solution is both in front and in back, upstream and downstream. And I think nursing homes are a really important part of that solution.”
Folded into that solution, she said, is the standardization and adoption of data elements that “really matter across care settings.”
“[The public health emergency] really signaled how much of the system actually needs to provide better care for people who are living with chronic illness, not just acute care, or care for one condition at a time, which can risk unintended, undesirable outcomes by chasing one disease and neglecting the other,” she said.
In regard to the amount of attention that long-term care has gotten as playing a role of lowering health care costs and improving quality within value-based payment models, she noted that while value-based care combines cost and quality for operators, it has to be affordable for patients as well.
“We have unique opportunities to synthesize care across the continuum,” she said. “Whether it’s home health or skilled nursing facilities or inpatient rehab facilities, or even at home with home health care needs, these are all considered in the post-acute care space.”
In regard to the changing landscape of healthcare delivery for older adults, Dr. Ling said that while community and home-based healthcare have specific benefits, nursing homes will continue to be a part of the landscape of care solutions, particularly because of the rise because of complexity and comorbidities within that the Medicare population has.
Technology will be helpful to understand the care needs of populations and to think about and redesign the kind of care operators provide, she said.
Still, she said it is important to keep in mind that technology is a tool, not a solution.
“We have to think about how to use these tools,” she said. “Use them effectively, thoughtfully, because they don’t replace how a human touch consoles someone. But the technology will evolve.”
Behavioral health strategies
The rising focus on the behavioral health needs of nursing home residents was a theme throughout the CLINICAL conference. CMS has drawn attention to the issue, including during a recent Open Door Forum call, and through actions such as targeted audits focused on inappropriate schizophrenia diagnoses and associated medication use.
Ling said that the administration’s behavioral health strategy also needs to be synthesized across the continuum, with a focus on three populations: people with substance use disorders, people with mental health conditions, and people with chronic pain.
Within nursing homes specifically, she flagged that the patient population is becoming more “heterogeneous” and includes people with chronic mental health conditions as well as physical conditions. Therefore, facilities are likely to have different needs and will require different skill sets based on their case mix.
“Part of the strategy is to build and adopt quality measurement,” she said. “Quality improvement strategies can focus on these populations, but using data to identify the hotspots, the bright spots, and where improvement is needed. From the CMS perspective, we have been applying those program and policy levers to raise the minimum safety standards and also the quality above the minimum in this space.”
She noted that the Quality Improvement Network and the Substance Abuse and Mental Health Services Administration (SAMHSA) can provide technical assistance to operators looking to improve mental health care for residents and patients.
“It’s no cost to the facility to really help with practice improvement, with best practices for those individuals who really do need therapeutic interventions for mental health conditions and people with serious mental illness,” she said.
And, as with staffing, she called on providers to share their experiences related to behavioral health, in the interest of disseminating best practices and informing quality measurement.
“That is something that we are really eager to learn from you all about so that we can together improve the quality of care that’s provided,” she said.
Companies featured in this article:
