When I got into the car Wednesday morning and turned on the radio, I knew I had barely missed the breaking news announcement. But it wasn’t hard to figure out what had occurred by what the sports radio talk show hosts were saying.
Tom Brady had “finally” retired. And this time it’s for good, they emphasized.
Maybe it is, and maybe it isn’t. Many people said the same thing when the seven-time Super Bowl champion quarterback announced his first retirement last year.
But then reality started to sink in more and more as the day wore on. The end of an era, it appears, is truly upon us.
Just two days earlier, long-term care providers learned a special era of their own would soon be ending. On May 11, nursing homes, and the rest of the country, will see the White House lift the public health emergency declaration.
To the largely maskless, already-moved-on general public, this brings a figurative shrug of the shoulders. To skilled nursing providers, who have suffered the most COVID-19 infections, deaths and vilification of any sector in the US, however, it ushers in an anxious new period. Soon, they will be without virtually all of their special-waiver safety cushions and numerous labor-saving measures.
For an industry buckled by historic labor shortages and operating costs, this is no occasion to cheer.
Some good news is the Centers for Medicare & Medicaid Services was true to its word and has already gradually shed many of the special pandemic protections. And it has warned plenty that those that aren’t gone yet would be taken away. So there’s that.
In fact, both an expert and a major provider executive I consulted this week independently said the end of the PHE should cause no major disruptions by the time the day comes.
That’s not to say there won’t be pain nor — just like the “good” ol’ days — more rough funding and regulatory battles.
Perhaps under the radar for some, many operators will be holding their breath that the feds — and seniors themselves — get the Medicaid redetermination process right so eligibility and funding keep flowing appropriately. Providers can take steps to help this happen more smoothly, as experts noted earlier this week.
First and foremost, however, will be heavy focus on the return to the three-night requirement for Medicare fee-for-service coverage. By all accounts, the suspension of this rule during the pandemic has been a godsend wherever beneficiaries have taken advantage of it.
It also has been an eye-opener because, as Sabra REIT President and CEO Rick Matros pointed out when we talked Tuesday, hospitals have found new appreciation for nursing facilities lately. Without their downstream care partners able to take as many post-acute patients, hospitals are feeling unusual pain in some locales and are clogged with patients they can’t move out.
Whether this will result in hospitals’ full-throated repudiation of the three-night rule, remains to be seen. My advice is not to hold your breath. But this new love — along with some sharp-pencil math — could boost skilled nursing providers in their quest to get the three-night requirement shelved for good.
Also, if as nursing home stakeholders claim, the rule is actually more expensive since hospital care costs so much more than skilled nursing care, a verdict should be easy to come by. Let the academic researchers flex their pivot tables and then hope for good results in the coming months. CMS, after all, will listen to a good dollars-and-cents argument as much as anyone. Especially if outcomes haven’t been harmed.
Somewhere in there, hospitals’ disingenuous overuse of “observation stay” status has to help the case to get rid of the three-night rule.
May 11, as it turns out, will be closing a door for providers. But at the same time, with a return to some of the age-old headaches it has always known, it will be opening a door to a new place that in some ways looks an awful lot like the old one.
James M. Berklan is McKnight’s Executive Editor.
Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.
