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 […]
Amid plans to launch the largest provider-owned institutional special needs plan (I-SNP) in the U.S., Brickyard Healthcare is also making sure it surpasses certain other challenges facing the sector. Along with this endeavor, eliminating agency use, preparing for managed Medicaid in Indiana, and being ready to face the staffing mandate, have all been top of […]
Over 50 lawmakers from both chambers of Congress are urging the Centers for Medicare and Medicaid Services (CMS) to increase scrutiny and regulation of artificial intelligence tools used by Medicare Advantage plans. In a letter addressed to CMS Administrator Chiquita Brooks-LaSure, the legislators expressed deep concerns over the use of AI algorithms by MA plans […]
Medicare Fee-for-Service, or traditional Medicare, admissions to nursing homes decreased significantly year over year by almost 20% in the fourth quarter of 2023. Coupled with this drop is a steady rise in Medicare Advantage enrollment, with such plans representing 54.7% of all beneficiaries enrolled in both Medicare Part A and B as of February, Trella […]
Operators have been opting for different payer sources other than Medicare Advantage plans given its persistent challenges. Medicare Advantage’s lower reimbursement rates compared to traditional Medicare and higher administrative burdens tied to prior authorizations and payment denials, have caused operators to seek even Medicaid as an alternative payer, emboldening efforts by advocacy groups to push […]
Expenditures for Nursing facilities and continuing care retirement communities (CCRCs) is expected to reach $237.6 billion in 2026, and $337.4 billion by 2032, according to data released Wednesday. Nursing homes and CCRCs have been increasing steadily since 2021, states a report prepared by the Office of the Actuary (OACT) at the Centers for Medicare & […]
Managed care’s growth across all health care settings, including nursing homes, has pushed reimbursement rates lower, and operators are implementing strategies to counter the situation. For starters, operators expressed the need to be well equipped for negotiating better rates with managed care organizations (MAOs). And, coming armed with cost of care data to the negotiating […]
If there’s no additional funding for the minimum staffing rule, well over 5% of existing facilities will close, depending on how successfully operators can pivot to meet the standard. The rates of closure may even reach 10% to 15%, depending on the market, cautioned sector leaders attending the LTC100 conference this week. Steve Nee, CEO […]
While Medicare Advantage (MA) has grown steadily in the last several years, leaders in the nursing home sector speculate whether increased federal regulation – and perhaps even more importantly, changes in the consumer experience – will slow its growth. This would come as a welcome development to many nursing home leaders, who have been struggling […]
Medicare Advantage plans might lower their payments to nursing homes in 2025, to absorb the federal government’s benchmark rate cut to insurers. Nursing home advocacy groups are worried that this move by the Centers for Medicare & Medicaid Services (CMS) to cut Medicare Advantage rates may be passed on to nursing home providers. The Medicare […]
Nursing homes in Pennsylvania face a critical underfunding of Medicaid, with one in four nursing home beds currently offline due to inadequate reimbursement. Survey findings from LeadingAge PA also point toward the continuing workforce shortage, as to why so many beds are not in use. About 48% of facilities in the state have had to […]
Conspicuously absent data on Medicare Advantage (MA), along with stagnated data collection overall by government agencies, should give nursing home operators cause for concern especially as this trend has influenced company advocacy and negotiating power when it comes to insurance plans. Having this data and understanding how it’s calculated can help operators “speak the same […]
As inadequate funding squeezes nursing homes dry, with Medicare Advantage reimbursing lower than traditional Medicare, and Medicaid funding decades behind on meeting cost of care, facilities are shifting operations to optimize reimbursement. But even that may not be enough. Richard Gamache, CEO of Aldersbridge Communities in Rhode Island, has had to make such operating decisions […]
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