CMS’s Regulatory Delay: What’s In, What’s Out, and Why Nursing Homes Could ‘Substantially’ Reduce Costs

Skilled nursing facilities could see relief from regulatory burdens if a proposed rule from the Centers for Medicare & Medicaid Services (CMS) takes effect, and according to the agency, it could lead to millions in savings. Specifically, the rule would overhaul multiple requirements and delay the implementation of regulations related to the Quality Assurance and […]

CMS Finalizes Reversal of Arbitration Ban in Nursing Homes, Proposes Partial Phase 3 RoP Delay

The federal government on Tuesday finalized a rule that allows skilled nursing operators to use arbitration agreements with their residents, while also proposing a new rule to reduce paperwork burdens that would delay certain aspects of the Requirements of Participation. The Centers for Medicare & Medicaid Services (CMS) struck something of a compromise with the […]

Specialists Help Drive Skilled Nursing Usage Cuts in ACOs

Multiple analyses have demonstrated that accountable care organizations (ACOs) reduce the use of skilled nursing facilities and other institutional post-acute care settings, and a new study may have identified a subtle culprit for the trend: specialist physicians. ACOs with the highest proportion of specialist visits had demonstrably lower rates of hospital admissions, skilled nursing encounters, […]

Boehler, Proponent of Post-Acute Care Bundles, to Leave Role as CMMI Chief

Adam Boehler will leave his position as the chief of the federal government’s top incubator for new payment models after an appointment to another office. President Trump late Wednesday nominated Boehler — who has served as director of the Center for Medicare & Medicaid Innovation (CMMI) since April 2018 — to become the CEO of […]

SNFs Serving Vulnerable Populations More Likely to Get Value-Based Penalties

The Medicare Value-Based Purchasing (VBP) program, which distributed its first round of incentives and penalties on October 1 of last year, has a goal of rewarding high-quality skilled nursing care by tying Medicare payments to performance. In that round, almost three-quarters of SNFs saw penalties. And a new study published this month in the journal […]

Proposed Mandatory Payment Model for Dialysis Could Have Skilled Nursing Promise

The federal government on Wednesday unveiled a new proposed payment model for certain kidney-related conditions, and several providers in the space say it could have serious potential for skilled nursing operators. Under the proposed End-Stage Renal Disease (ESRD) Treatment Choices (ETC) model, Medicare would expand coverage of care for kidney diseases and offer financial incentives […]

As PDPM Looms, Providers Must Balance Desire to Boost Payments with Audit Dangers

Under the Patient-Driven Payment Model (PDPM), reimbursement for Medicare Part A patients in skilled nursing facilities will be driven by patient condition, rather than by therapy minutes provided to that patient. It’s a change that the industry has hailed as an opportunity to receive financial credit for the care that they’re already providing, but they […]

Home Health Produces Worse Outcomes for Sicker Seniors Than Skilled Nursing

While governments and payers increasingly incentivize the provision of long-term care at home instead of in skilled nursing facilities, data about outcomes remains few and far between — with one group of researchers finding that some high-acuity patients fare worse in the community setting. Based on 2012 claims data, a team from the University of […]

Judge Throws Out False Claims Act Case Against ManorCare Hospice Arm

A False Claims Act (FCA) case against HCR ManorCare’s Heartland hospice affiliates was dismissed with prejudice on Wednesday by Judge James Carr of the U.S. District Court for the Northern District of Ohio. The government had previously declined to intervene in the qui tam complaint made by Kathi Holloway, who worked as a regional hospice consultant […]

Coding, Scoring, and Accuracy: Three Key Points of Attack for PDPM

With October 1 a few short months away, skilled nursing providers should be well into their preparations for the Patient-Driven Payment Model (PDPM), the overhaul of Medicare Part A reimbursement that’s set to take effect at the start of the new fiscal year. The new requirements include a variety of new possibilities for payment, since […]

Bill Would Bring New Quality Measures to Skilled Nursing Value-Based Purchasing Program

A bipartisan pair of U.S. representatives late last week submitted legislation that would potentially bring new quality measures to the federal Value-Based Purchasing (VBP) program. HR 3406, introduced in the House of Representatives last Friday, would empower the Centers for Medicare & Medicaid Services (CMS) to roll out up to 10 additional metrics for inclusion […]

Confessions of a Skilled Nursing Operator: ‘ACOs Have Been a Disaster for SNFs’

With the U.S. health care system lumbering toward value-based care and grappling with how to match payments with outcomes, accountable care organizations (ACOs) have come under the spotlight. But despite conflicting reports about their capacity to produce savings and improve care, one operator tells Skilled Nursing News that there is no doubt about one thing: […]

Hospital Exec: ‘Almost Nothing’ Won’t Move to the Home Amid Shift to Lower-Cost Care Settings

The siphoning of residents from skilled nursing facilities into the home health space remains a troubling trend for institutional operators, and an executive at one of the nation’s largest health systems sees nothing but acceleration ahead. “There’s almost nothing that won’t eventually move to the home,” Scott Powder, chief strategy officer of Advocate Aurora Health, […]

ACOs Generated Slight Medicare Savings from 2013 to 2016 in New Calculation

Accountable care organizations (ACOs) have generated a slight reduction in overall Medicare spending, a new analysis found — adding another viewpoint to a growing and occasionally contradictory body of research. The Medicare Payment Advisory Commission (MedPAC) determined that ACOs led to a 1 to 2 percentage-point drop in Medicare outlays between 2013 and 2016, though […]

MedPAC: SNFs, Other Post-Acute Providers Base Assessments on Payments, Not Resident Need

A top government watchdog and advocate for Medicare payment reform on Friday accused post-acute care providers of using mandatory functional assessments to boost payments instead of accurately recording patient needs. As part of its sprawling annual report to Congress on reimbursement issues, the Medicare Payment Advisory Commission (MedPAC) probed the differences between individual residents’ functional […]

PDPM Could Create Risk-Sharing Opportunities, Headaches for Skilled Nursing

Risk-sharing has loomed large in health care reform efforts over the last decade, and the new Medicare payment model for skilled nursing facilities could open up additional avenues for operators to take control — along with pointed questions from partners along the spectrum. The Patient-Driven Payment Model (PDPM) marks a step toward a long-teased site-neutral […]