The main lessons learned from the 2021 AHCA convention and exhibition – Guest Columns



Tamar Abell

Attending the 2021 American Health Care Association (AHCA) Convention and Exhibition this year was like reuniting with friends after spending two years on the front lines of a battlefield.

The group was tired, suffering from PTSD, but happy to be among the survivors. Most of the sessions focused on the “new standard in LTC” – and how to press the reset button. One thing was certain: as an SLD professional, I was not alone, but on the contrary, I was part of a very special team.

Here are the main “lessons learned” that I would like to highlight after attending the conference:

This is what we chose – this is who we are. “

Ultimately, this is the common theme for long-term care professionals. Being in this industry is a calling. We get beaten up, but we dust ourselves off and move on. A recurring conversation was not to downplay the trauma we have experienced as an industry.

At every level, from loss of life to media disparagement of LTC professionals, we have earned the badge of “heroes of health”. Our staff need to be supported and to receive mental health support and guidance. PTSD is real.


Really, that’s all I have to say. Unless you are a SINGLE facility, this is the most serious problem plaguing our industry. The AHCA’s government relations update made it clear that staffing is the number one challenge they are tackling on many fronts. Participants expressed general concern about mandatory staffing – not the concept itself, but the lack of tools and resources to implement such requirements.

There was also discussion of the “price hike” by nursing staffing agencies when many facilities are unable to accept admissions due to staff shortages. To their credit, AHCA is exploring creative approaches to the personnel issue, including working with Afghan immigration agencies to find personnel.

But if you’re looking for help finding staff shortage solutions from the Centers for Medicare & Medicaid Services, look again. In his speech, CMS’s Evan Schulman acknowledged that they (CMS) were not aware of all the challenges that providers face in recruiting and retaining staff, but that providers need to do “as much as they can under their control… they are not helpless and can Don’t say there is nothing more to do… it’s not just about having bodies in place.

Mr. Schulman, this is where I disagree. I work with all kinds of providers, from large urban to small rural, and the pain is real. As we all try to be creative, to open hearts and portfolios, the staff situation is dire and we look to CMS to help out with problem solving. Showing turnover rates and integrating it into the five-star quality rating system isn’t the answer to the workforce crisis – it’s time to get more creative.

The bottom line for staffing? Buckle up… this problem isn’t going to go away anytime soon.


While the predictions were that the PDPM would be budget neutral, it actually increased payments to SNFs in the first year by $ 1.7 billion! You can bet the government will recalibrate the system. The recalibration will be accompanied by increased monitoring of the use of resources by the suppliers. It is more important than ever to continue to regularly monitor and analyze your PDPM data.

If CMS is looking at the data, we need to do it first! We specifically want to assess changes in the MDS coding pattern – are there real changes in the population and improvements in the ratings or is there a “game” in the system? It is essential that vendors show results with respect to PDPM coding changes to avoid potential compliance issues. Speaking of compliance….

Compliance is more important than ever

In this new COVID world, robust compliance is no longer optional. The compliance officer needs to ask the tough questions, and their role needs to become much broader than checking exclusion checks and phone calls. We need to make sure that facilities have a way to self-assess and self-correct, with access to data being a key element.

Last but not least, the update of the CMS

It’s always a pleasure to watch CMS updates… I’ve said enough. This one deserves its own article – but here’s a high-level rundown. This episode is called “Don’t Shoot the Messenger – Part 352”.

To have. Vaccination. Rates. Up

Mr Schulman was very clear: a major impetus for CMS is to vaccinate staff and residents and reopen the doors. Again – no surprise here. With a federal mandate to vaccinate or lose staff, Mr. Shulman preached to the choir. Suppliers explained that the staff shortage is so overwhelming that it is impossible to impose another barrier. He further stressed that infection control guidelines must be strictly followed and that masking is not going anywhere. It’s all about risk management.

Visiting residents

Schulman verified what providers already knew – the separation of families has been as heartbreaking as the physical effects of the virus. CMS is working on a policy to help increase visits. One suggestion is, as the holiday season approaches, to schedule the tours to avoid an influx of guests. FYI, you can find out about the vaccination status of visitors, but you cannot restrict visits based on status.

Back to basics

CMS reports a decline in quality since the COVID outbreak. With the understaffing and the focus on COVID / infection control, that was to be expected. With the rise of investigations, you can expect increased monitoring of mobility, weight loss, pressure sores, and the use of mind-altering medications. In addition, there is a huge backlog of inquiries and compliant investigations that need to be completed. When asked how far the polls would go, Mr. Schulman’s response was “CMS will take a reasonable approach.”

And of the 3 ROP deployment, Shulman said, “A lot depends on how things go over the next few months and there is a ministerial sensitivity to what is being asked of the LTC community.” He stressed that everyone should be focused on having a phase 3 based infection prevention program in place – don’t wait for the application.

So, dear readers, I am ending where I started – this is what we chose, this is who we are. We must keep riding this wave and don’t let the tsunami hit you!

Tamar Abell is CEO of TBA Compliance, an advisory group specializing in developing relevant and operational compliance programs for long-term care facilities. In addition, the team works with organizations in the implementation of corporate integrity agreements on quality of care.

The opinions expressed in McKnight Long Term Care News guest submissions are those of the author and not necessarily those of McKnight Long Term Care News or its editors.


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