Nursing homes and continuing care retirement communities (CCRCs) made up $191.3 billion of national health expenditures in 2022, an increase from $181.1 billion in 2021, reaching levels close to the onset of the Covid-19 pandemic. Pre-pandemic, such expenditures sat between $162 billion and $174.1 billion between 2016 and 2019, according to a survey published by […]
Category: Medicare Advantage
In facing a class-action lawsuit for its use of artificial intelligence in denying claims for services to residents in post-acute care, Humana (NYSE: HUM) joins the ranks of other health insurance behemoths such United Healthcare and Cigna. The complaint, filed late Tuesday, in a federal court in Kentucky, accuses Humana of using AI tools – […]
Minimum Data Set (MDS) changes for 2024, along with updates to nursing home surveys were top of mind among representatives of the Centers for Medicare & Medicaid Services on Thursday, as the agency outlined its plans for next year in an Open Door Forum. CMS plans to release the MDS 1.19.1 in early 2024 with […]
In order to keep Medicare Advantage plans in check for denial of services, provider organizations are pressuring federal authorities to do more, and asking them to closely monitor and aggressively enforce reforms for these plans as envisioned in a final rule that takes effect on Jan. 1. Companies managing MA plans have said they don’t […]
The costs of long-term care in every setting, including nursing homes, is considered out of reach for most seniors, averaging more than $100 per day nationwide. This is coupled with the fact that the majority of older adults with very low incomes will need such services and have the fewest resources to pay for them. […]
Operational pressures continue to shape the landscape of the skilled nursing sector as many organizations with assets across the care continuum are divesting nursing homes in favor of other service lines. Responding to pressures from staffing and low reimbursements, Ohio Living decided to act “proactively” and downsize its skilling nursing segment while growing its services […]
From managed care burdens and “punitive, vindictive surveys,” to threats posed by the potential federal staffing mandate and issues stemming from the “radically broken” Five Star rating system, Ignite Medical Resorts CEO Tim Fields is well aware of the many challenges facing skilled nursing providers. But as Ignite celebrates its fifth year as a company […]
United Church Homes (UCH) is continuing to make progress on a recently announced value-based care play with health plan provider CareSource, while responding to the ongoing market and regulatory pressures in the nursing home space. In June, UCH — with a portfolio of about 1,600 senior housing and care units, including 600 nursing home units […]
UnitedHealthcare, a unit of UnitedHealth Group (NYSE: UNH), is facing a federal lawsuit over its use of an artificial intelligence tool in making Medicare Advantage claims denials for patients in extended care facilities. That same issue was at the center of a recently published piece in STAT, a health-oriented news outlet. Aaron Albright, a spokesperson […]
As the Centers for Medicare & Medicaid Services (CMS) looks into more oversight for Medicare Advantage (MA), some progressive lawmakers are urging caution over Medicaid Advantage plans – long lamented among those in the nursing home industry – over deceptive advertising and high rates of denial for services. Members of Congress discussed pitfalls of Medicare […]
The proposed federal staffing mandate is a potential “kill factor” for nursing home providers, while the rise of Medicare Advantage (MA) is a “major challenge” — and how well the sector responds to these threats will play a major part in shaping the future. This is the perspective of Phil Fogg Jr., CEO of Marquis […]
The latest proposed changes to the REACH accountable care organization (ACO) may make it even easier for skilled nursing facilities to be a part of an ACO program – and there may be implications for quality of care, industry leaders said. A broadened criteria and an attractive high needs population track is expected to be […]
As managed care plans continue to reshape the skilled nursing landscape, operators must navigate the complexities of managing patients under managed healthcare programs, including maintaining patient census levels, adapting to industry-specific policies, and addressing issues related to case managers’ involvement. As Medicare Advantage continues to penetrate the nursing home market, leaders have said that MA […]
Hospital systems and skilled nursing facilities are redefining their relationships in response to manifold challenges and changes affecting the continuum of care. One example: In the midst of the Covid-19 public health emergency, NorthShore University HealthSystem — which became the third-largest health care delivery system in Illinois after a 2022 merger with Edward-Elmhurst Health — […]
As nursing home organizations adjust to a changing environment of reimbursement, Medicare Advantage Institutional Special Needs Plans (I-SNPs) are undergoing rapid growth, with operators pursuing distinct strategies meant to realize financial and operational gains. The benefits of an I-SNP can range from more control over quality, happier clinical staff, reduced administrative burdens, improved compensation and […]
The rise of managed care plans among nursing home beneficiaries has meant that nursing home providers have had to make tough choices to balance the pros and cons of such plans to reap profits. And, despite a proven track record of handling higher acuity, many providers may not think to use this to their advantage […]
Following the Biden Administration’s bid this week to reduce the price of certain drugs – many of which are commonly used in nursing homes – experts are cautioning that the changes may negatively impact the bottomline of organizations in the sector. As Medicare Part D price negotiations for these drugs come into focus this week, […]
It appears the Centers for Medicare & Medicaid Services (CMS) is paying particular attention to managed care payers as the agency re-examines data submission requirements for skilled nursing services through the Minimum Data Set (MDS). Nursing home operators were able to comment on various MDS-related questions posed by CMS officials during a Quality Reporting Program […]
Some nursing homes are seeing “significantly more” audits tied to managed care and dual plan Medicaid claims in certain states – and potentially could see the same from Medicare too. This is all on top of an improper payment probe the Centers for Medicare & Medicaid Services (CMS) is conducting for Patient-Driven Payment Model (PDPM) […]
As managed care plans become more and more relevant to the nursing home industry, it appears Medicare Advantage beneficiaries are experiencing less favorable outcomes, while using less post-acute care services than those on traditional fee-for-service Medicare. A study published in JAMA Health Forum on Friday suggests that MA enrollees reported less functional improvement while using […]
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