With New Value-Based Care Play and Smaller SNF Portfolio, United Church Homes Looks to Future

United Church Homes (UCH), which provides a range of care and services to older adults in skilled nursing centers and other settings, is making a value-based care play that involves health plan provider CareSource.  Ohio-based UCH and Metta Healthcare, the parent company of Ohio’s Hospice and Pure Healthcare, are forming a new nonprofit entity called […]

Evolving Nursing Home Business Model Sees Rise of Third-Party Docs, Therapists, Back Office Staff

As rising acuity and reimbursement challenges stymy nursing home workforce growth, third party contracts have been increasingly responsible for providing daily services. Whether its providing resident-facing clinical work, including use of third party doctors, supplying medical equipment or rendering back office services that focus more on ensuring proper documentation for reimbursement, third parties are increasingly […]

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 […]

How Nursing Homes Can Find Value Via New Ways of Partnering with Managed Care Plans

As value-based care increasingly becomes more prevalent in the nursing home industry, providers continue to straddle traditional Medicare fee for service (FFS) and a plethora of managed care plans. But there are arrangements that can allow organizations to be both payer and provider, or partner with those that already occupy both worlds. Amy Kaszak, executive […]

PDPM is a Start, But Rising Acuity at Nursing Homes Demands Building New Payment Models for Adequate Reimbursement 

As acuity continues to rise among nursing home residents, providers say reimbursement needs to change too – and not just the dollar amount. Incentives should be based on quality of care, and the industry will need to build out specific reimbursement models to match expanded acuity specialities, especially as value-based care becomes more and more […]

CMS: Dual Eligible Medicare Advantage Enrollees, Including in Nursing Homes, Received Worse Clinical Care 

Medicare Advantage enrollees, specifically those dually eligible for Medicare and Medicaid and a low-income subsidy, received worse clinical care than those who didn’t fall under these plans. That’s according to a report released on Tuesday by the Medicare & Medicaid Services’ Office of Minority Health (CMS OMH). More than one in ten, or 13%, of […]

Elmbrook CEO Coble: Nursing Home Operators Must Prepare for End of Fee-For-Service Medicare

Oklahoma-based Elmbrook Management has doubled in size since 2018, and now is in the process of transforming from a skilled nursing provider into a population health management organization. Doing so is necessary to prepare for the future, as fee-for-service Medicare is rapidly being eclipsed by managed care models, Elmbrook CEO Tom Coble said on the […]

Humana, Longevity Health Announce National ISNP Partnership, Target More Than a Dozen States 

Longevity Health Plan and Humana Inc. (NYSE: HUM) announced a partnership to expand institutional special needs plan (ISNP) offerings that support the requirements of Medicare-eligible individuals living in skilled nursing facilities. The partnership will begin in South Carolina and Georgia this year and will expand to additional states in 2024 and 2025. The two companies […]

Ensign CEO: Feds’ Staffing Mandate May Include Long Phase-In, Lots of ‘Wood to Chop’ on Big California Portfolio

Nursing home operators may see a long phase-in for a federal minimum staffing requirement, and a host of exceptions, when more details finally come – but, it’s difficult to speculate on hypotheticals and may not help operators to dwell on the “what-ifs.” That’s according to Ensign Group (Nasdaq: ENSG) CEO Barry Port, who weighed in […]

Shortage of Skilled Nursing Beds, Best Buy Effect, Managed Care Growth Accelerate SNF-at-Home

Like many markets across the country, the Twin Cities in Minnesota are confronting a reduction in skilled nursing beds, which is forcing patients to remain in hospitals for longer periods of time — with skilled nursing-at-home gaining momentum as a solution to these discharge pressures. “The average length-of-stay on the hospital side is eight days […]

Principle LTC CFO: Facing Immense Financial Pressures, Skilled Nursing Operators Must Know ‘Why’ Behind Key Metrics

Chief financial officers of skilled nursing facilities are increasingly collaborating with the front line while paying close attention to key operational metrics. Such evolutions in the role are crucial, given immense financial pressures caused by the skyrocketing cost of care and low Medicaid reimbursement rates. CFOs in the space would do well to collect real-time […]

Beyond MDS Coordinators: Nursing Home Operators Add Reimbursement Specialist Roles, Tap Leaders with ‘C-Suite Mindset’

Given increasing complexities in payment systems and intensifying financial pressures, more nursing home providers are hiring leaders with a specialized and sophisticated focus on reimbursement. Even smaller operators are seeing the value of these positions, which demand a mix of financial and clinical acumen, and a C-suite mindset. Valerie Taylor, for one, became a corporate […]

AI Use by Medicare Advantage Blamed for Increased Denial of Nursing Home Services

Over-reliance on artificial intelligence is compromising post-acute care for nursing home residents on Medicare Advantage plans. This view of the problematic use of algorithms for prior authorizations – and denial based on incorrect assessment of patient needs – is at the center of reporting and analysis published in the health, medicine and life sciences publication, […]

Trilogy CEO: Clinical Initiatives Gain Momentum, Medicare Advantage Decisions Expected in 2023

Trilogy Health Services last week announced the appointment of the company’s first-ever chief medical officer, naming Dr. Andrew McNamara to the post. Appointing a CMO is just the latest step in Trilogy’s concerted, multi-year effort to elevate clinical care. The push can be traced to 2019, when Leigh Ann Barney became CEO. “People asked, what’s […]

CMS Proposal Marks Shift After Years of Skilled Nursing Frustration with Medicare Advantage Diversions

The Centers for Medicare & Medicaid Services (CMS) has decided to take action on transitions in care – specifically Medicare Advantage (MA) plans diverting care to home health instead of skilled nursing – after years of skilled nursing industry and consumer feedback. CMS last month took steps to address the trend with a proposed rule […]

Executive Outlook 2023: Reimagine How We Deliver Skilled Nursing Care

“The sector has a tremendous opportunity to reimagine how we deliver care.” These are the words of Nate Schema, president and CEO of The Evangelical Lutheran Good Samaritan Society, one of the largest providers of skilled nursing services in the United States. Good Sam is reimagining care in part through a $350 million virtual care […]

Executive Outlook 2023: A New Playbook for Skilled Nursing

Over the last two years, skilled nursing providers have faced a pandemic and a labor crisis. As 2023 dawns, leaders across the industry are taking stock of their changed organizations and a reshaped business environment, and are preparing to execute strategies formulated in the COVID crucible. As Signature HealthCARE CEO Joe Steier puts it: “Every […]

CMS Seeks to Stop Diversion of Some Medicare Advantage Patients from SNFs to Home Health

The Centers for Medicare & Medicaid Services (CMS) is taking steps to ensure that patients are not inappropriately denied coverage for post-acute care in particular settings — including skilled nursing facilities — by Medicare Advantage organizations (MAOs). CMS raised the issue as part of a proposed rule issued on Dec. 15, stating that MAOs generally […]

The Quotes That Defined Skilled Nursing in 2022 — and Hint at What’s Ahead

The top quotes of 2022 memorably captured some of the biggest skilled nursing issues of the year, from “shocking” payment policies to “colossal” regulatory issues to “transformative” changes. The quotes below not only serve as reminders about what transpired over the last 12 months, but touch on many issues that are still pressing as 2023 […]