Success in Medicare Advantage requires health plans leaders be forward-looking and prepared for programmatic changes to risk adjustment. Preparing for programmatic changes to risk adjustment requires a three-pronged approach – assess, educate, forecast.
Heath plans need to adequately and thoroughly assess their risk adjustment practices to gain a clear understanding of their accuracy. Implementing an internal assessment mechanism, such as a claims hold, is key to identifying where you need to adjust for new methodologies and changing regulations. However, assessment alone is not enough and must be followed by proper education to improve organization-wide performance.
Education is a core component of building a forward-looking risk adjustment program. Plans cannot be forward-looking without appropriately educating staff on both their individual job and the larger importance of accurate risk adjustment and how it impacts the health plan. Education should not be limited to just health plan staff but should also include training and workshops for providers – especially those at risk for coding inaccuracies.
Finally, plan leaders must focus on forecasting by creating performance projections and ensuring collaboration with finance teams. Having a tight projection of where you will land is essential for current market conditions but will also put you in the best position to pivot when programmatic changes arrive.
Hospitals across the United States are seeing rising numbers of Covid-19 patients coinciding with a nationwide shortage of health care workers, straining many hospitals and leading the American Nurses Association (ANA) to call for HHS to declare the shortage a national crisis.
The Covid-19 pandemic has made the already-existing shortage of health care workers even worse, and as a result, many hospitals are scrambling to keep up with surges in Covid-19 patients.
"We are running short on resources," Sid Fletcher, chief clinical officer at Novant Health, said. "We're in this as a united front. This is something that isn't unique to any one health care system. It's really all of us in this together."
Fletcher said hospitals are being forced to redeploy staff from other areas to help and are determining what non-urgent procedures can be postponed.
Randy Tobler, CEO of Scotland County Hospital in Missouri, said a staff shortage has forced his hospital to hire more travel nurses at "crazy" rates of at least $200 an hour—rates Tobler said his small hospital can't afford.
According to Joseph Brown, an interventional radiology tech at Sutter Roseville Medical Center, staff shortages have had a domino effect on the rest of the hospital staff. Brown said more of his coworkers are going on stress or medical leave, leaving nurses' aides to care for even more patients.
"Explain to me how you get 15 people up to a toilet, do the vitals, change the beds, provide the care you're supposed to provide for 15 people in an eight-hour shift, and not injure yourself," Brown said.
The staff shortage has led many hospitals to adjust their hiring processes. According to a survey from Aon that polled 150 health systems representing over 1,150 hospitals between April and June, around 40% of health care facilities said they're accelerating their hiring processes to keep up with demand.
To attract more employees, 93% of surveyed facilities are offering enhanced benefits packages, MedCity News reports. Of the total survey respondents:
In addition, 77% of respondents said they plan to pay at least 76% of their employees' health care costs, while 23% said they'll offer a no-cost health plan to a portion of their employees.
"The top priority in 2020 was to mitigate rising costs for the employer—understandably, given the financial shock that health systems were reeling from," Sheena Singh, SVP of Aon's national health care industry practice, said. "Now, the pandemic has exacerbated a labor shortage that could impact patient care delivery, delay attainment of organizational objectives, and accelerate burnout among clinical staff."
In response to the nationwide shortage of nurses, ANA in a letter to HHS Secretary Xavier Becerra said the agency should declare the shortage a national crisis and work to address it.
"[T]he delta variant is causing [Covid-19] cases to soar, overrunning hospital and staff capacity," ANA president Ernest Grant wrote in the letter. "These current circumstances have only exacerbated underlying, chronic nursing workforce challenges that have persisted for years."
"ANA is deeply concerned that this severe shortage of nurses, especially in areas experiencing high numbers of Covid-19 cases, will have long-term repercussions for the profession, the entire health care delivery system, and ultimately, on the health of the nation," Grant wrote.
Grant added that it is "imperative that HHS utilize all available authorities to address this issue."
As of last week, around 39% of hospitals in the United States had announced vaccine mandates for their staff, according to Colin Milligan, a spokesperson for the American Hospital Association. Some hospitals—especially smaller ones—are worried that implementing a vaccine mandate could make their staff shortages worse.
"Obviously it's going to be a real challenge for these small, rural hospitals to mandate a vaccine when they're already facing such significant workforce shortages," Alan Morgan, head of the National Rural Health Association, said.
This could also become an issue for nursing homes, as last month, the Biden administration announced it will require all nursing home staff to be vaccinated or risk the facility losing federal funding. According to CMS data, around 62% of nursing home and long-term care facility workers are fully or partially vaccinated.
Mark Parkinson, CEO of the American Health Care Association and National Center for Assisted Living, said in a letter to HHS Secretary Becerra that he's concerned about the potential impact of the policy.
"If a significant portion of the approximately 38% of unvaccinated nursing home staff leave, the net impact will be worse care for the residents," Parkinson said in the letter. "While the loss of just half of the unvaccinated staff would be devastating to care, the loss of even one or two staff in a nursing home impacts care on certain shifts and units."
Though some health care professionals could choose to leave specific health systems with mandates—or the workforce altogether—Advisory Board's Monica Westhead says these vaccine mandates are better for providers in the long term, as they will retain existing and attract potential workers who want to be in a safer environment, and likely reduce the number of employees' sick days. (Vaidya, MedCity News, 9/2; Hudson, Charlotte Business Journal, 9/2; Weixel, The Hill, 9/4; Weber, Kaiser Health News, 8/31; Davis, HealthLeaders Media, 9/2)
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