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) […]
A Medicare Advantage bundled payment model for hip and knee replacements offered by Humana (NYSE: HUM) was associated with reduced skilled nursing facility use. These bundled payments were also linked to reduced spending overall for lower extremity joint replacements (LEJR) – while maintaining quality of care, according to a study published in JAMA Network. Of […]
Concerns about lack of skilled nursing access for cancer patients, as well as oncology-related costs borne by skilled nursing facilities, have prompted operators to call for action from the Centers for Medicare & Medicaid Services (CMS). Several nursing home professionals raised this issue in comments to CMS’ proposed Medicare payment update for 2024. One oncology […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
As Medicare Advantage continues to penetrate the nursing home market, leaders say that MA plans are depressing margins amid higher costs to run operations. This might lead some operators to contemplate closing, while others will be wiser to hire staff in designated roles to help them negotiate better rates – and exclusions – for managed […]
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 […]
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 […]
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 […]
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 […]
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 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 […]
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 […]
“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 […]
By continuing to use the site, you agree to the use of cookies. More Information
The cookie settings on this website are set to "allow cookies" to give you the best browsing experience possible. If you continue to use this website without changing your cookie settings or you click "Accept" below then you are consenting to this. For more information, see our cookie policy.
