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Overcoming the biggest challenges facing skilled nursing facilities today

Over the last few years, skilled nursing facilities have been put through the wringer as they’ve grappled with a new Medicare payment model, higher acuity patients, declining reimbursements, increased regulatory scrutiny and most recently, the COVID-19 pandemic and staff turnover.

Staying afloat in this ever-changing post-acute care industry can be an uphill battle; however, it is not insurmountable. Adopting technology to simplify quality management is key to remaining financially viable while delivering high quality care.

Here are the four most significant clinical burdens SNFs are facing today, with tips on how your organization can overcome them.

Challenge #1: Maintaining clinical quality performance

SNFs are caring for patients with greater medical complexity as the overall population ages and hospitals discharge ill patients sooner. Higher acuity rates strain SNF resources and require higher staffing levels to maintain quality care.

At the same time, facilities must report key performance indicators required by CMS and reflected in the regulatory agency’s Five-Star Quality Rating System to assess quality, such as:


  • Daily staffing levels via the Payroll-Based Journal (PBJ) system
  • Several different Quality Measures (QMs) related to the physical and clinical needs of residents
  • Results from recent health inspections based on CMS minimum quality requirements

Tip: Implement technology that streamlines quality reporting and monitoring and offers data insights for continuous performance improvement.

Challenge #2: Keeping up with changing reimbursement policies

Reimbursements are the financial lifeblood of SNFs so there’s no question the stress of staying afloat in the face of changing and diminishing reimbursements is real.

The Patient Driven Payment Model (PDPM), for example, upended how SNFs were accustomed to being reimbursed, by shifting from payments based on volume to quality.

Though the industry is acclimated to the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program, which rewards facilities with incentive payments linked to the quality of care they provide to their fee-for-service Medicare patients, changes may be coming.

The Medicare Payment Advisory Commission (MEDPAC) recently recommended to Congress the elimination of the current SNF VBP program in favor of a new value incentive program (VIP). The new initiative would include several quality measures, a change in distribution of rewards, and would account for differences in patientssocial risk factors.

Tip: Use an application that helps you manage PDPM and SNF VBP revenue, keeps you up to date with changing policies and provides real-time and predictive reporting.

Challenge #3: Staying accountable and compliant

When it comes to regulatory compliance, documentation integrity and accountability are key. With SNFs under increased scrutiny in light of the COVID-19 pandemic, these factors have taken on greater weight.

The Triple Check Process is fundamental to ensuring billing accuracy and compliance with regulatory guidelines. Because of all the steps involved, there is a lot of room for error.

A properly conducted Triple Check ensures medical necessity and diagnoses are supported by clinical documentation, and MDS assessments are submitted on time and match the UB-04. Getting this process right means the difference between a paid and unpaid claim.

Tip: Automate this time-consuming process to ensure MDS accuracy before assessment and submission.

Challenge #4: Managing operational burdens

The pandemic has magnified the operational issues of the post-acute industry. SNFs face daily operational challenges and risks, such as retaining adequate staffing, ensuring the safety of workers and residents, managing infection control, and operating on thin margins.

A recent survey conducted by the American Healthcare Association and National Center for Assisted Living found that 65% of post-acute facilities are currently operating at a loss and 90% have profit margins of 3% or less. In fact, as many as 66% say they could close in 2021 because of COVID-19 costs.

Tip: Find a platform that helps you oversee operations, minimizing risk and infection incidence while boosting efficiencies for a better bottom line.

Thriving through the changes

Fortunately, your facility doesn’t have to face these challenges alone. With Inovalon, you have access to one suite of applications that keeps patient care at the forefront and helps your skilled nursing business thrive.

Prefer a visual depiction of the challenges and solutions? Check out our infographic.

About the author

Michelle Karl, Solution Architect