By Tom Jegou, CPP, Compliance Expert at SmartLinx Solutions
The Better Care Reconciliation Act (BCRA) — formerly known as the American Health Care Act (AHCA) — is currently in the Senate awaiting review, revision, and voting, after which, if the bill passes, it will be sent to the House once more, and finally to the president for signing. Navigating the BCRA and its provisions can be confusing, but the SmartLinx Research Team has been analyzing the bill and has laid out the most important action steps for your facility as it braces for one of the biggest impacts of the BCRA: a massive decrease in Medicaid funding.
Under the BCRA as it is currently written, the federal government would end its matching of state spending on Medicaid and instead set a cap on federal funding per enrollee. This constraint means that states will have less Medicaid funding, making it harder to get reimbursed for your facility’s patients. A similar decrease proposed by the AHCA was estimated to save the federal government an estimated $800 billion over the next 10 years, likely at the cost of long-term care and other healthcare facilities.
Here are the most important steps to take now, in order to compensate for the potential decrease in revenue:
Be More Efficient
With the federal government reducing Medicaid funding, it is imperative for LTC and healthcare facilities to drive up efficiency wherever possible. If passed in its current form, the BCRA will make it more difficult to get reimbursed for your facility’s patients, which can be extremely detrimental to your facility’s revenue — if you’re not prepared. To compensate, your facility must maximize revenue and minimize cost. Management of your workforce, one of the largest expenses of LTC and healthcare facilities, is essential in increasing ROI. Schedule optimization as well as time and attendance management are key here, as they help eliminate a significant expenditure for LTC facilities: overtime.
Be More Precise
Currently mandated reporting can already prove to be a long and arduous process; the Payroll-Based Journal remains hard to execute properly without a software solution to help. It is important to note that while PBJ reporting is untouched by the BCRA, failure or mistakes in reporting can still lead to a black mark next to your facility’s name on the Medicare.gov nursing home database. Furthermore, starting in 2018, the CMS will use the data from your 2017 Payroll-Based Journals to calculate your Five-Star ratings, with failure to report leading to a suppression of your rating. As such, having accurate and easily verifiable data in the case of an audit will be instrumental in preserving your facility’s rating and image.
Be More Informed
Not all reporting measures will be untouched by the BCRA. Unlike PBJ reporting, 1095-C reporting seems likely to undergo changes in the future, making remaining compliant a complicated subject. Though its future is uncertain for now, late 1095-C reporting can still result in a fine as high as $260 per person, and failure to report can cause that fine to soar to $530 per person. As such, it is important to have a reporting solution within your workforce management software that is malleable in the case of any changes in requirements. Look for software that is supported by industry experts who can facilitate the best practices for maintaining a compliant status to avoid penalties and maximize revenue.
Be More Engaging
A shortage of skilled nurses already exists in the long-term care industry, and with less funding from Medicaid, the ability to recruit and retain skilled employees is only going to grow harder. The first and most important step is using the best tools to ensure that:
- You are hiring the right candidates
- Your staff is well trained and certified
Retention then becomes a matter of using the best technology to make your employees’ jobs a little easier and more engaging. By ensuring your employees are properly scheduled and have easy, mobile access to key information and functions, employee satisfaction and the overall quality of care you provide will increase.
Be More Competitive
The potential switch to the BCRA may prove to be particularly challenging to skilled nursing facilities already struggling to maintain more nuanced quality measures. As some states begin switching to a Value-Based Payment system for Medicaid reimbursements — a system that puts emphasis on quality measures such as staff tardiness and ratings from patients on the overall quality of their care, as seen in New York — facilities with lower quality ratings may find themselves receiving reduced Medicaid reimbursements. This will come in addition to the already degraded federal Medicaid funding, further damaging revenue. Having the right workforce management tools to maintain both a compliant and quality-inducing staff-to-patient ratio will be imperative to keeping your quality ratings high. Acting to improve the quality of your facility and its management now, before the BCRA even has a chance to take effect, is essential to remain a strong contender under these highly competitive circumstances.
By following these tips, your facility will be ready to face the changes and challenges expected with the BCRA. While the BCRA is constantly at risk of changing, the SmartLinx Research Team is hard at work following the bill to keep you up to date on the latest provisions and revisions that you need to know to stay ahead of the competition.
Don’t know where to start? SmartLinx Solutions’ suite of workforce management tools can help!