As we look back on 2024, we wanted to take a moment and reflect on the many changes, challenges, and opportunities that we embraced during the year. While our team does not provide direct care, we do support clients who serve on the front line across the healthcare continuum. From emergency room doctors to urgent care nurses, physical therapists, and nursing home administrators, we engage with a diverse group of individuals who are dealing with the everyday concerns of residents and patients.
So, what did we learn from them in 2024 and expect to change in 2025?
We began 2024 with a major focus on the schizophrenia diagnosis in skilled nursing facilities. Beginning in 2023, and as the new year began, the Centers for Medicare and Medicaid Services (CMS) was making quite a stir with their renewed focus on behavioral health in long-term care. They spent much of 2023 performing targeted audits that were having a major impact on the Quality Measures domains at providers who were found to be inaccurately coding, per their standards. We thought this was going to continue to be a focus well into 2024. But, alas, the furor seems to have subsided a bit – which is great for providers!
2024 was also a big year for exclusions checks. This seemingly routine process has proven to not be as routine as many organizations think. Repeatedly, we heard of providers relying on their human resources information systems (HRIS) and procurement systems to perform these checks. Unfortunately, these pieces of software are usually only performing the bare minimum number of checks against the most common data sets. In contrast, LW Consulting’s LWEnSCheck® Exclusions Software offers the ability to validate against 99 sanction and licensure sources, tailoring to the specific needs of each business. Throughout 2024, we have seen instances where our expanded data sets have prevented providers from working with excluded individuals and entities that they might not have discovered otherwise. As CMS and the Office of Inspector General (OIG) become better at using data analytics, we predict that this area will continue to see a rise in prominence through 2025.
Lastly, we cannot overemphasize the impact that the Loper Bright ruling will have on healthcare delivery going forward. There seems to be a spectrum of opinions on this topic, ranging from individuals who are optimistic that nothing is going to change, to pessimists who think that every aspect of CMS regulation will be challenged going forward. As with anything, the answer likely lies somewhere in the middle. What we do know is that several major law firms are already working on cases that will challenge CMS’s ability to regulate healthcare providers and rate their performance. Nothing has shifted in the immediate aftermath of the ruling, but 2025 is likely to see major changes due to this decision. As we welcome the New Year, we know it will entail another twelve months of learning, recalibrating, and adjusting to a changing compliance landscape. Sure, we could allow it to keep us up at night or perhaps give us some heartburn. But we’re compliance professionals; this is what we thrive on! If you find that the challenges of the coming year are weighing heavily on you, perhaps we can be of assistance.
LW Consulting, Inc. (LWCI) offers a comprehensive range of services that can assist your organization in maintaining compliance, identifying trends, providing education and training, or conducting documentation and coding audits. For more information, contact LWCI to connect with one of our experts!
