Geriatric Practice Solutions, A Division of Healthcare Practice Solutions, LLC
2024 Post-Acute/Long-Term Care (PA/LTC) Medicine Predictions
 
As we move into 2024, the Post-Acute/Long-Term Care (PA/LTC) Medicine industry is expected to undergo significant changes. Here are some of the predictions for the year ahead:
 

1. 1. Following long-established consolidation trends in other medical specialties, small independent PA/LTC medical practices will need to affiliate with or be consumed by larger practices.

 2. PA/LTC medical practices that have waited out joining Accountable Care Organizations or other value-based medicine programs will have to jump in to try to capture revenue lost to fee for service schedule fee cuts and the continued growth of lesser paying Medicare Advantage payors.

3. With Medicare Advantage payors controlling 50% or more of the Medicare enrollees in many markets, specific operating policies and procedures will need to be put in place, replacing the historical one-size fee-for-service fits all approach.  

4. Successful PA/LTC Medicine practices will create and expand upon formal operating relationships with the operations and clinical leadership of PA/LTC community operators. Institutional Special Needs Plans (I-SNPs) will specifically drive facility operators to expand upon the current focus on averaging metrics such as return to hospital rate and focus on individual resident/patient performance metrics.  

5. Big data management and artificial intelligence will impact PA/LTC practices. Medicare Advantage is heavily invested in AI as are Medicare Value Based Reimbursement players, some of whom are heavily capitalized with venture capital.  

​These predictions suggest that the PA/LTC Medicine industry is poised for meaningful change in the coming year. It will be important for providers to stay up to date with these changes and adapt their practices accordingly.

Introduction: The landscape of post-acute/long-term healthcare is undergoing a significant transformation with the emergence and growing traction of value-based payment programs initiated by Medicare. As skilled nursing, long-term care, and assisted living (PALTC) facilities navigate this shifting paradigm, there is an urgent need to reevaluate their relationship with the medical practices that provide professional medical services to their residents. Traditionally siloed, the relationship between facility operator leadership and medical practice leadership must evolve into an integrated partnership. This article delves into the imperative for PALTC facilities and medical practices to establish new day-to-day operating relationships to effectively respond to Medicare's value-based payment initiatives.
 
The Challenge of Value-Based Payment: Medicare's transition towards value-based payment programs signals a fundamental shift in healthcare reimbursement. Unlike the traditional fee-for-service model, value-based payment incorporates quality of care and patient outcomes. PALTC facilities and medical practices are now mutually accountable for delivering patient-centered care that not only promotes optimizing resident health and mental well-being but requires service delivery in a model that reduces overall costs associated with this patient population to receive program bonus payments.
 
Breaking Down Silos: Historically, PALTC facilities and medical practices have functioned independently, with limited collaboration beyond clinicians and facility leadership. This siloed approach impedes seamless care coordination focus on aligned goals and can result in lost quality and financial opportunity for both parties. As value-based payment programs take center stage, it is imperative to bridge the divide between these entities to provide medical and residential services that meet resident/family needs, meet, or exceed survey standards and result in everyone’s’ financial success.
 
The Case for Integrated Partnerships: 

1. Enhanced Patient Outcomes: Collaborative partnerships enable PALTC facilities and medical practices to work cohesively towards achieving superior patient outcomes. Streamlined communication and shared data facilitate informed decision-making, reducing the risk of medical errors and enhancing recovery rates.

 

1. Continuity of Care: An integrated approach ensures a smooth transition for patients as they move from acute care settings to PALTC facilities and beyond. This continuity of care minimizes disruptions and enhances patient well-being.

 

1. Optimized Resource Allocation: By working together from the same operations plan that shares insights and expertise, medical practices and PALTC facilities can optimize resource allocation. This can include improved staff scheduling, fewer unnecessary emergency department and hospital transfers, and judicious use of company and practice resources.

 

1. Preventive Care Focus: Integrated partnerships encourage a proactive approach to healthcare. By collaborating on focused measures and wellness initiatives, medical practices and facilities can optimize Medicare and other payor reimbursement.

 
 
Building Integrated Operating Relationships: 

1. Open Communication Channels: PALTC facilities and medical practices must establish clear communication channels to facilitate the exchange of patient information, treatment plans, and progress updates. Well-planned meetings reviewing key performance metrics and joint case reviews can foster mutual understanding.

 

1. Shared Data and Technology: Optimizing the use of interoperable electronic health records (EHR) systems allows for real-time access to patient data, enabling informed decision-making and more appropriate care delivery.

 

1. Joint Care Planning: Collaboratively develop care plans that span medical, rehabilitative, and psychosocial aspects. This approach ensures a comprehensive approach to patient well-being and efficient operations.

 

1. Staff Training and Collaboration: Train staff from both medical practices and facilities to understand each other's roles and responsibilities. Joint training sessions can foster a culture of collaboration. While mutual morale building should be an outcome of this initiative, the primary focus is to identify and implement changes in behavior that achieve improved results.

 
The Role of Leadership: Effective integration requires leadership commitment from both PALTC facilities and medical practices. Leaders should initiate and nurture collaborative efforts, setting the tone for a unified approach to patient care.
 
Conclusion: As Medicare's value-based payment programs reshape the healthcare landscape, PALTC facilities and medical practices must respond with innovative, patient-centered strategies. The traditional siloed relationship between facility operator leadership and medical practice leadership is no longer sustainable. By forging new day-to-day operating relationships that prioritize integration, open communication, and shared goals, these entities can deliver the quality care and financial outcomes that the evolving healthcare ecosystem demands. Through collaboration, PALTC facilities and medical practices pave the way for a brighter and more integrated future in healthcare delivery.

After attending The Society for Post-Acute and Long-Term Care Annual Conference in Tampa last week, it has become abundantly clear to GPS that the move from the traditional fee-for-service model to value-based payment (VBP) models is well under way and growing.  For example, in 2022, nearly half of (48%) eligible Medicare beneficiaries – 28.4 million people out of 58.6 million Medicare beneficiaries overall – are enrolled in Medicare Advantage plans. Medicare Advantage enrollment as a share of the eligible Medicare population has more than doubled from 2007 to 2022 (19% to 48%). The percentages vary from market to market, but the reality that traditional fee-for-service Medicare is under siege and will not ultimately survive.

The presenters at the conference shared information about several VBP models that, in addition to Medicare Advantage plans, are redesigning the way elder care services are reimbursed and, as a result, changing the way elder care services are delivered. They also confirmed that The Centers for Medicare and Medicaid Services (CMS) intent to have no fee-for-service beneficiaries by 2030 is sincere and that over time the replacement VBP models will implement increasingly stringent metrics for providers to get reimbursed which could lead to reduced actual reimbursement. Similar to what has happened with recent fee schedule adjustments but potentially on steroids.

It has become abundantly clear that these decisions by CMS are creating an “adapt or die” period in the business cycles of PA/LTC medical practices. Practices that are owned by clinicians that want to retire or otherwise exit this sector of healthcare may be happy to ride things until they want to shutter or sell their practice. Another alternative is to go ahead and sell now because there are entrepreneurial investors both inside and outside of this market sector that believe they can make money, at least in the short term, based on the current VBP models promulgated by CMS. Or there may be hybrid models where practice owners can decide to partner with one or more of the VBP focused entities that are aggregating the number of Medicare beneficiaries under their contract with CMS.
GPS has been following these developments closely and can assist PA/LTC Practice Leaders evaluate what is occurring in the market. Change is rarely easy, but the difference between success and failure may be to become educated and make informed decisions. If you are evaluating the options between:

• maintaining the status quo
• joining a Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO)
• joining a Realizing Equity, Access, and Community Health (REACH) ACO
• selling your practice
• etc.​

please consider calling GPS at (804) 403-3833 for a no-risk consultation.