While 2025 remains a bit uncertain due to the federal staffing mandate and a new White House administration, leaders in the nursing home industry plan to continue working toward improving quality of care, addressing workforce challenges and advocating for fair regulation and reimbursements. Clif Porter, president and CEO of the American Health Care Association/National Center […]
For some nursing home providers, adding new business lines and more brick-and-mortar locations ensures greater longevity by providing better cushioning against larger economic forces. This philosophy allows for a lot of freedom when growing the business, and it keeps nursing home operators from sitting still in a challenging and constantly changing environment. According to Leslie […]
It’s no surprise that the Biden administration’s minimum staffing mandate was the source of Skilled Nursing News’ most-read story of 2024. From the proposal stage to its final form, our stories on the staffing mandate covered all aspects of its requirements as well as the legal and legislative challenges against it. Our stories about the […]
The nursing home industry has been on a wild ride this past year, with major regulation up in the air and a flip in the White House leaving operators unsure of whether they should applaud or brace for impact. Rhetoric surrounding the federal minimum staffing mandate has changed drastically throughout the year, with leaders condemning […]
Brian Thompson, the CEO of UnitedHealthcare, on Wednesday morning was fatally shot outside a hotel in Midtown Manhattan. Thompson was in NYC for a company investor conference, reports said; police on Wednesday afternoon were still looking for the gunman, who was last spotted in Central Park. Thompson’s death affects the leadership of one of the […]
The Centers for Medicare & Medicaid Services (CMS) is taking new steps to improve Medicare Advantage (MA) access and transparency, including reforms to prior authorizations and the use of AI tools to deny coverage, as outlined in the 2026 Medicare Advantage and Part D proposed rule, officials said during a call on Tuesday. The Contract […]
President-elect Donald Trump has picked Dr. Mehmet Oz, the renowned celebrity physician, to serve as administrator of the Centers for Medicare & Medicaid Services (CMS). The appointment was announced on Tuesday afternoon. “Our broken Healthcare System harms everyday Americans, and crushes our Country’s budget. Dr. Oz will be a leader in incentivizing Disease Prevention, so […]
Of the many significant factors affecting the skilled nursing industry in the last five years, Medicare Advantage was named as a major disruptor, as cost reports show a shift in operating margins with more facilities struggling financially. Stephen Taylor, principal of senior living and care segment leader for CliftonLarsonAllen (CLA), said MA has had “one […]
Optum is scaling back its Medicare Advantage Special Needs Plans for nursing home and assisted living residents in several regions. The health care services arm of insurance giant UnitedHealth Group (NYSE: UHG), Optum, made headlines earlier this year for workforce cuts. Now, the company is shutting down Institutional Special Needs Plans (I-SNPs) in several states, […]
While prior authorization has a legitimate role in Medicare Advantage coverage, the practice has expanded to the point of negatively affecting care. This aspect of MA needs to be right sized, and likely through legislation, nursing home leaders said. About 90%-plus of physicians, including those serving nursing home patients, have said that one or more […]
Medicare Advantage’s prior authorization process has resulted in higher denial rates among three of the largest health insurance providers, whose use of predictive AI tools raises serious concerns about patient care, according to a new report issued by a Senate subcommittee on Thursday. “[F]or beneficiaries of Medicare Advantage [prior authorization] has become not just a […]
Staffing shortages and increased acuity of patients are playing a big role in referral placement, along with preferences and prerequisites of referral sources. This is causing nursing homes and hospitals in high-demand areas to get creative with in-house offerings and hospital partnerships, as they are still experiencing bottlenecks in the referral process. At the same […]
Nursing homes and hospitals are developing closer ties and improving communication, and with this trend, admissions into nursing homes are expected to increase as rehospitalizations and excessive lengths of stay are also seen as declining. With rising acuity and staffing shortages of recent years, nursing homes have often been reluctant in admitting challenging cases that […]
Longevity Health and Infinity Healthcare Consulting on Wednesday announced a joint venture for institutional special needs plans (I-SNPs), marking Longevity’s entry into three new states, along with the expansion of its existing business into an additional state. Longevity and Infinity’s clients will collaborate to assist I-SNP members living in Infinity nursing facilities across Indiana, Kentucky […]
In weathering the rise of managed care penetration – which has often meant lost profits – nursing homes are turning to centralized processes for handling claims, beefing up teams to handle additional documentation requests (ADRs), and closely tracking contract renewals. Rates for managed care plans like Medicare Advantage are often lower than traditional fee-for-service Medicare […]
Coming off of his first year as CEO of American Senior Communities Steve Van Camp is busy planning an Institutional Special Needs Plan (I-SNP) joint venture with five other providers in Indiana, while also devoting time and resources to meeting quality measures and outcomes among ASC facilities. Important considerations to forge ahead with these efforts […]
Customer service, staff wellbeing, and tackling low reimbursement rates are some of the top priorities for nursing home operators as they prepare for the future. And educating and supporting care teams is especially important in order to strategize with the quality measures that will be implemented in the coming years, as these will have an […]
Negotiating power with Medicare Advantage (MA) plans may become easier as nursing homes explore participation in bundled payment options such as the Transforming Episode Accountability Model (TEAM), which enables following patients through an entire episode of care. It’s a lever available to participants and collaborators to forge new contracting strategies with their MA plan and […]
The national Medicare Advantage beneficiary admissions to nursing homes increased by 21.2% in 2021, and Medicare fee-for-service (FFS) admissions in the sector decreased by 13.8% between 2022 and 2023. Trella Health captured this data in its post-acute care industry trend report for 2024, confirming what the industry has been saying about the rise of MA […]
There’s been a flurry of regulatory activity related to Medicare Advantage (MA) in the first half of this year, with many policy actions being the result of extensive advocacy efforts among nursing home organizations. However, many of the regulations – such as those related to prior authorizations for certain services – as they stand are […]
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