Of an estimated 36 million Americans with a family member or friend in a nursing home, only 37% say their loved one is receiving high-quality care. And political affiliation aside, older adults want public policies that support and improve quality care. That’s according to a study issued by The John A. Hartford Foundation. Based on […]
Category: Medicare
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 […]
When looking at the 4.2% Medicare increase in the Skilled Nursing Facility Prospective Payment System (SNF PPS) for 2025, some leaders in the space wonder if the rate calculated has been inadequate considering inflation, labor woes, and funds needed to meet the federal staffing mandate. Some even argue that rate increases are so far behind […]
Delivering care to dual eligible nursing home residents can be complex with so many payers involved in the industry, but aligning incentives, quality measures and tools for providers can help operators serve this demographic. Dual eligible residents, or those that can receive benefits from both Medicare and Medicaid, often find themselves in a “tangled web […]
Nursing home operators say the civil monetary penalty (CMP) expansion is proving to be one of the most problematic features of the 2025 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule. Initially, there was excitement for the Medicare payment increase, but this has turned to dread for operators who are already dealing with […]
The Centers for Medicare & Medicaid Services (CMS) late Wednesday finalized its 2025 Skilled Nursing Facility Prospective Payment System (SNF PPS) rule, approving a net increase of 4.2%, or approximately $1.4 billion in Medicare Part A payments for next year. The increase is calculated based on the SNF market basket percentage increase of 3%, plus […]
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 […]
Despite operational and financial headwinds affecting the nursing home sector currently, a transitional care program and physiatry partnership has been able to cut readmission rates from 29% to 9% among a group of facilities. OSF HealthCare, a 17-hospital system in Illinois and Michigan, partnered with physiatry and care coordination management group Puzzle Healthcare to deliver […]
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 […]
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 […]
The “super SNF,” an insider term used for nursing homes that serve mostly high acuity patients, is evolving to enhance its specialized function, and leaders in the space believe it will be a replacement – or at least a supplement – for long-term acute care hospitals (LTACHs) and inpatient rehabilitation facilities (IRFs). The latest changes […]
The Centers for Medicare & Medicaid Services’ (CMS) in April released a bundled payment model that is the culmination of the best aspects from such past models, all to align with the agency’s efforts to get all Medicare Fee-for-Service beneficiaries involved in value-based care by 2030. The Transforming Episode Accountability Model, or TEAM, is considered […]
Nursing home residents with Alzheimer’s disease and related dementias (ADRD) appear to benefit from greater nurse practitioner (NP) involvement, with fewer hospitalizations and higher hospice use at end of life. The number of differences in outcomes between extensive and minimal NP care was higher in states with a full scope of practice regulations than in […]
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 […]
Despite a 17.5% Medicaid increase last year, at least 25 nursing homes closed in Pennsylvania since the pandemic began – and a significant financial shortfall remains, leaders said. Closures equate to a loss of 2,588 certified nursing home beds in the state since 2020. The continued workforce shortage and underfunding of Medicaid made closures and […]
The Centers for Medicare & Medicaid Services (CMS) is testing out a payment model that would cover all costs associated with an episode of care, including a skilled nursing stay, but it appears that select hospitals would be in the driver’s seat if approved. Certain surgical procedures will fall under the new model and include […]
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