‘Astronomical’ Medicare Advantage Denials, Pre-Auth Issues Cause Outcry from Nursing Homes

The Medicare Advantage preauthorization process and denials of care are a growing concern across the continuum, and nursing home operators and advocates — as well as federal lawmakers — are pushing more urgently for change. Such concerns are not new, and already some action has been taken: the Centers for Medicare & Medicaid Services (CMS) […]

Western U.S. Nursing Homes Inadequately Prepared for Wildfire Risk, Need Better Oversight

Nursing homes facing an increased risk of local wildfires in the Mountain West and Pacific Northwest regions had deficiencies in emergency preparedness, while reinspection for these facilities also lagged. This is according to a new study published on Monday in JAMA Network Open. The study evaluated whether nursing homes that are at elevated risk of […]

Optum to Acquire Amedisys, Parent Company of SNF-at-Home Provider Contessa Health

Optum, the diversified care delivery arm of UnitedHealth Group (NYSE: UNH), has reached an agreement to acquire home health giant Amedisys (Nasdaq: AMED), which provides skilled nursing facility-at-home services via Contessa Health. Optum emerged as a suitor for Amedisys earlier this month, after the home health giant had previously announced a deal to combine with […]

ChatGPT and Beyond: How Artificial Intelligence is Shaping the Future of Nursing Home Operations

Use of artificial intelligence (AI) has been steadily increasing at nursing homes, as the technology begins to deliver on its promises to improve efficiencies in a wide variety of areas, from clinical outcomes to back-office work. And while ChatGPT is the attention-grabber these days, natural language processing is but one of the ways AI is […]

Efforts to Rein In Nursing Home Temp Agencies Gain Ground After ‘Price Gouging,’ Other Troubling Practices

It’s no secret that temporary staffing agencies have been both a boon and bane for the nursing home industry, providing necessary but very costly labor during the pandemic. Staffing problems have persisted long enough in the post-Covid era to warrant their use, but pricing practices have led to an outcry and push for state regulation. […]

CMS Releases New Data on Medicare Advantage Beneficiaries’ Use of Skilled Nursing   

In 2019, there were about 46.6 skilled nursing facility stays per 1,000 Medicare Advantage beneficiaries on a national basis. That’s according to data released Monday by the Centers for Medicare & Medicaid Services (CMS), on the utilization of skilled nursing facilities among beneficiaries enrolled in Medicare Advantage plans. The data also showed there were about […]

Ciena Healthcare CEO: Despite ‘Good PR,’ Rise of Managed Care is Harming Nursing Home Sector

The nursing home industry is still saddled with several serious challenges – labor and funding issues included – as it struggles to recover and survive. And, it feels imprudent for the federal government to increase regulation of the sector, particularly as managed care companies continue unchecked as they create more pressures on nursing homes. This […]

‘Backed into a Corner’: Over 500 Nursing Home Providers Gather to Protest Looming Minimum Staffing Proposal

Nursing home industry leaders, more than 500 of whom gathered on Capitol Hill this week to influence workforce legislation, sounded alarms over the possibility of a minimum staffing rule at the conclusion of their meeting with policy makers Tuesday. At a time when the industry is still reeling from the effects of massive worker shortages […]

CEO of LTC ACO: Too Many SNFs Still ‘Missing Out on Substantial Shared Savings,’ Despite Value-Based Care Growth

The challenges of Covid-19 and its aftermath have made it difficult for some skilled nursing facilities to increase their engagement in value-based care — but they are at risk of falling behind as the health care system continues to evolve, and they are also potentially leaving money on the table. That’s according to Jason Feuerman, […]

CMS Approves Medicare Coverage for New Alzheimer’s Drugs to Facilitate Research

New approved drugs for Alzheimer’s may be covered by Medicare if patients meet the conditions of showing cognitive decline and early onset of dementia, the Centers for Medicare & Medicaid Services (CMS) said Thursday. Administrator Chiquita Brooks-LaSure shared the process for access and coverage by Medicare for such Alzheimer’s drugs that are currently pending approval […]

American Senior Communities Announces Steve Van Camp as New CEO

American Senior Communities announced Thursday that Steve Van Camp will become its new CEO effective June 1. Van Camp will replace Donna Kelsey, who is expected to remain with the company as a senior advisor, ASC said in a press release. “I am confident in Steve’s ability to keep delivering quality care as the top […]

‘A Black Box’: Advocates Decry Opaqueness of Medicare Advantage Denials as Senators Seek Clarity on Process

As a Senate subcommittee continues to seek additional information on Medicare Advantage care denials through May, nursing home advocacy groups have issued detailed recommendations that underline lack of transparency, administrative burdens and low reimbursements associated with MA plans. The Senate Homeland Security & Government Affairs Permanent Subcommittee on Investigations held a hearing on Wednesday that […]

Innovation and Uncertainty: Nursing Home Providers Forge New Paths for a Post-Covid Era

As the Skilled Nursing News’ CLINICAL event in Washington D.C. came to a close last month, industry experts left with staffing concerns amid labor shortages and pending legislation on minimum staffing standards. However, operators also shared optimism over their innovations in corporate and clinical practices as they continued to confront higher acuity and tighter regulation. […]

‘System in Crisis’: US Senate Hearing Calls for More Funding, Staffing for Nursing Home Inspections

The nursing home inspections system is underfunded and understaffed and needs federal assistance for alleviating inspection backlogs, or residents will remain in peril, experts and legislators said at a U.S. Senate hearing on Thursday. Officials from the long-term care ombudsman program as well as leaders from state inspections and regulatory bodies were among those who […]

‘Complete Debacle’: US House Hearing on Nursing Home Covid Deaths Blames Political Acrimony, Policies, Staffing

Bad policy decisions, political acrimony and poor staffing were to blame for the alarming number of deaths in nursing homes, experts and legislators said in a U.S. House of Representatives hearing held on Wednesday. As Democratic and Republican lawmakers pointed fingers at each other, they agreed that among the many deficiencies, the must-admit policy deeply […]

AHCA’s CEO: Nursing Homes Must Prepare for ‘Massive’ Staffing Mandate Battle, Adapt to Managed Care ‘Mega-Trend’

Nursing homes are past the “nightmare” caused by Covid-19, but now are facing “a real business problem” that could be considerably worsened by the coming federal staffing mandate. That’s according to Mark Parkinson, CEO and president of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL). He spoke Tuesday of the urgent need to […]