Assessing the Biggest Challenges in Skilled Nursing Facilities

Over recent years, skilled nursing facilities have faced significant pressure as they navigate a new Medicare payment system, rising patient complexity, declining reimbursements, growing regulatory oversight, and most recently, challenges related to COVID-19 and staff turnover.

Operating successfully in this demanding post-acute care environment is difficult, but not impossible. Leveraging technology to simplify quality management is essential for staying financially stable while providing strong patient care.

Below are the four main clinical challenges SNFs encounter today, along with practical ways your organization can address them.

Challenge #1: Maintaining Clinical Performance Standards

SNFs are now caring for patients with more complex medical needs due to an aging population and shorter hospital stays. Higher patient acuity puts pressure on resources and requires additional staffing to maintain quality care.

At the same time, facilities must submit key performance metrics as required by CMS, which factor into the Five-Star Quality Rating System, including:

• Daily staffing data through the Payroll-Based Journal (PBJ)
• Various Quality Measures (QMs) reflecting residents’ physical and clinical requirements
• Results from recent health inspections based on CMS minimum standards

Tip: Use technology that simplifies quality reporting and monitoring while offering insights to support continuous improvement.

Challenge #2: Adapting to Changing Reimbursement Policies

Reimbursement is critical to SNF operations, and keeping up with policy changes is a major challenge.

The Patient Driven Payment Model (PDPM) altered traditional payment structures, shifting focus from volume to quality. Facilities are already familiar with the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program, which provides incentive payments tied to care quality, but further changes are anticipated.

The Medicare Payment Advisory Commission (MEDPAC) recently suggested to Congress that the current SNF VBP program be replaced with a new Value Incentive Program (VIP), which would adjust reward distribution, include additional quality measures, and account for patients’ social risk factors.

Tip: Adopt a solution that tracks PDPM and SNF VBP revenue, keeps you updated on policy changes, and offers real-time and predictive reporting.

Challenge #3: Ensuring Accountability and Compliance

Strong documentation and accountability are essential for regulatory compliance, especially as SNFs face heightened oversight following the COVID-19 pandemic.

The Triple Check Process is key to maintaining billing accuracy and compliance. With multiple steps involved, errors are common.

A correct Triple Check confirms that medical necessity and diagnoses are documented properly, MDS assessments are submitted timely, and they match UB-04 forms. Accuracy here directly impacts whether claims are paid or denied.

Tip: Automate this process to verify MDS accuracy before assessment and submission, reducing errors and saving time.

Challenge #4: Managing Operations

Operational demands have intensified in the post-acute sector due to the pandemic. SNFs face challenges such as staffing shortages, safety of residents and staff, infection control, and tight financial margins.

A survey by the American Healthcare Association and National Center for Assisted Living showed 65% of post-acute facilities are operating at a loss, 90% report profit margins under 3%, and 66% feared closure in 2021 due to COVID-19-related costs.

Tip: Choose software that streamlines operations, reduces risks, supports infection control, and improves efficiency to protect your bottom line.

Also Read: The Biggest Documentation Risks in Skilled Nursing Facilities

Staying Ahead of Challenges

Fortunately, your facility doesn’t need to face these pressures alone. There are platforms that offer a unified set of applications designed to keep patient care central while helping skilled nursing operations remain strong and sustainable.