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 […]

AHCA CEO: Value-Based Care ‘Most Exciting’ Development of His 30-Year Skilled Nursing Career

by Paul Bergeron Skilled nursing providers are facing an extremely challenging operating environment, but they must keep adapting and innovating as the shift toward value-based care continues across the U.S. health care system. And in fact, providers have tremendous opportunities to seize. “Value-based care through the population health management model is the most exciting thing […]

CMS Data Shows Upswing in Hospital Discharges to SNFs Reversed in May 2022 

Between the summer of 2021 all the way through May of this year, hospitals increasingly discharged Medicare beneficiaries with Covid-19 to the skilled nursing facility setting, only to drop back down in June. The proportion of Covid-19 hospitalization discharges per month to a SNF increased by 8% from July 2021 to May 2022, cresting 20% […]

What the Eventual End of the Public Health Emergency Will Mean For Nursing Home Operators

Despite the federal government’s likely decision to keep the public health emergency (PHE) in place past January, the nursing home industry continues to prepare for operations without the safety net of certain waivers. Leaders in the space say any continuation of PHE waivers – temporary or permanent – should be dependent on cost and patient […]

How Therapy Providers Can Drive SNF Upside and Optimize Reimbursement

Therapy providers in the nursing home space believe their role in increasing mobility will contribute to upside in the sector – especially within the context of the Patient-Driven Payment Model (PDPM), pandemic recovery and staffing challenges. It’s a draw for prospective residents and their families, both on the short-term and long-term side, as clinical improvements […]

Inbound Health Launches with $20M Round, Intentions to Scale SNF-at-Home

Minnesota-based health system Allina Health has partnered with venture capital firm Flare Capital Partners to take its SNF-at-home and hospital-at-home programs to a national platform. Allina and Flare Capital Partners announced a $20 million fundraising round on Tuesday for its new standalone company Inbound Health, a platform that enables health systems and health plans to […]

Nursing Home Workforce, Medicare Advantage, Therapy Pay in Focus on Capitol Hill

While the spotlight on skilled nursing continues to shine bright, an election year has advocacy groups certain that legislative efforts will be pared down to just a couple key pieces Congress aims to tackle this fall. Policy dedicated to boosting a floundering workforce, expanding telehealth beyond public health emergency (PHE) waivers, and streamlining authorization processes […]

More Nursing Homes Look for Upside by Plugging Into Medicare Advantage

As Medicare Advantage (MA) plans continue to expand in benefits and number of beneficiaries, nursing home operators are weighing their options on how to adapt. “If you start to think about positioning with your relationships, with these types of organizations, be it a provider network, a member that has an Institutional Special Needs Plan (I-SNP) […]

Medicare Advantage’s Steady Growth Has Nursing Home Operators Moving in ‘Radically Different Directions’

While so many nursing home trends have been altered by the pandemic, one has interestingly stayed in line with pre-pandemic statistics: Medicare Advantage’s (MA) growth trajectory. MA is still expected to cover 52.9% of all Medicare beneficiaries by 2031, according to Fred Bentley, managing director at ATI Advisory. Bentley spoke about Medicare’s evolution and its […]

‘Powerful Data’ Could Inform CMS’ Nursing Home Minimum Staffing Standards

As federal minimum staffing requirements loom for skilled nursing providers, analysts with the Medicare Payment Advisory Commission (MedPAC) unveiled crucial data detailing the effects of state-level standards on the industry. While research found state minimum staffing requirements increased staffing levels and in some cases improved quality measures, there were some unintended consequences: a decrease in […]

Industry Leaders Split on Whether Skilled Nursing’s Future Should Include Separate Short, Long-Term Care

There has been an increasing call to separate long-term and short-term care in the nursing home sector as acuity rises and facilities take on more specialities, all while facing a staffing shortage. Academics, finance leaders and some operators agree such a separation would be a positive for residents — and maybe even help the staffing […]

Why Nursing Home Operators Shouldn’t Fear SNF-at-Home — At Least For Now

Skilled nursing operators shouldn’t be scared of losing market share to the shift to home trend, including SNF-at-home – at least not in the near-term. Instead, operators need to look at shifts to home-based care as an opportunity to diversify business lines in the future, as patient preference, Medicare Advantage (MA) plans and technology advancements […]

Home Health Surpassed SNF Use in 2020 Among Medicare Beneficiaries

Home health agencies surpassed skilled nursing facilities as the most sought after post-acute care setting – SNF care went from most common to second-most used among Medicare beneficiaries, crossing paths with home health in February 2020 as the pandemic ramped up. By March 2020, the number of hospital discharges referred to SNFs dropped to 16.6% […]