Many of your clients will eventually use the arrangements you have helped them make to pay for long-term care services.
Steve Shain may be helping the facilities or home care services those clients use get paid.
Shain is chief operating officer if LTC Contracting, an arm of LTC Consulting Services of Lakewood, New Jersey.
Shain helps get nursing homes and other providers of long-term care services into the networks of managed care plans, including Medicare Advantage plan networks, commercial major medical networks, and managed Medicaid networks.
Other divisions of LTC Consulting Services help facilities get the payers to pay.
Here are some other things Shain talked about in a recent interview.
Shain’s clients do not get many patients who have private, stand-alone long-term care insurance.
When patients do arrive with private LTCI, the facilities usually ask the patients or their families to pay the facilities themselves, then seek reimbursement from the insurers, because determining what any given policy will cover can be tricky, Shain said.
Shain’s clients love seeing patients come in with Medicare skilled nursing facility benefits, and they are comfortable with taking Medicaid patients.
If Medicare would offer LTC benefits, “I think that is something they would be ecstatic about,” he said.
Helping patients qualify to get Medicaid nursing home benefits can take time, but, once people do start getting the benefits, Medicaid tends to be a steady payer, Shain said.
2. Patient-Driven Payment Model
In the acute care world, doctors often talk about “value-based plans,” or “patient-centered care.”
For Shain, the buzzword that matters is “Patient-Driven Payment Model,” or PDPM.
The Centers for Medicare and Medicaid Services wants to use the PDPM approach to hold own the cost of skilled nursing facility care for Medicare fee-for-service enrollees.
CMS hopes to use the PDPM to make payments to facilities based on each patient’s condition and care needs, rather than on the amount of care provided.
CMS is preparing to shift to the PDPM approach Oct. 1.
The approach is part of the CMS “Patients Over Paperwork” initiative.
3. Medicare Advantage Long-Term Care Benefits
Carriers may have a hard time adding major chronic care benefits to Medicare Advantage plans by Jan. 1, 2019, Shain said.
But many providers have contracts that start on same date other than Jan. 1, he said.
He expects to see issuers start testing chronic care benefits programs in 2019, and he expects to see some of the pilot programs start in the middle of the year.
Shain’s company is working with a company that will be providing telemedicine consultations through kiosks in retail stores for patients of all ages.
Although many companies and researchers talk about how valuable telemedicine should be for home health care purposes, Shain has not run into much in-home use of telemedicine services at his company.
Where Shain has seen active use of telemedicine in long-term care is in nursing homes, assisted living facilities and other facilities.
The facilities tend to have the technical resources to get good Internet connections and telemedicine software up and running, and they can use telemedicine to enhance the care their own health care professionals provide, Shain said.
Just a few years ago, big, publicly traded companies were bragging about all of the long-term care facilities they had bought.
Now, Shain said, he thinks the dominant long-term care deal story involves the big, national players selling facilities one at a time, or a few at a time, to local or regional players.
“Large chains couldn’t maintain the right level of focus,” Shain said.
Some of the local and regional facility owners may do well and begin buying other facilities, but “it really can’t revert back to the way it was,” with large national players buying everything in sight, he said.
— Read Home Care Market Maker Sees Aide Shortage, on ThinkAdvisor.