Skilled Nursing Operators Shouldn’t Count on Investors to Share PDPM Optimism

With just two weeks to go before the new payment model for nursing homes takes effect, operators that have prepared for the changes could be expecting a significant boost in their Medicare reimbursements. But providers shouldn’t necessarily expect their investors to share in their optimism over the Patient-Driven Payment Model (PDPM). Over the course of […]

Record-Setting $1.3B Nursing Home Fraud Case Ends in 20-Year Prison Sentence

Philip Esformes, who used to control a network of skilled nursing and assisted living facilities running from Miami to Chicago, was sentenced to 20 years in prison on Thursday. The legal publication Law360 first reported the news. The U.S. Justice Department called the case, which resulted in 20 guilty verdicts in April, the largest single […]

UnitedHealth’s I-SNPs Reduced Readmissions, Emergency Visits While Boosting Skilled Nursing Use

In-house Medicare Advantage plans have emerged as a hot trend in the skilled nursing space, as operators look for ways to take control over their reimbursement destiny — and a new study shows that the model could have real benefits for both patients and Medicare at large. Members enrolled in insurance giant UnitedHealthcare’s Institutional Special […]

Why Skilled Nursing Operators Can’t Bank on ‘Silver Tsunami’ — or One Good Month Under PDPM — for Relief

As the post-acute and long-term health care industry struggles through shortened lengths of stay and compressed reimbursements, an oasis has lingered just beyond the horizon: the so-called silver tsunami. If operators can wait out the current downturn, the thinking goes, the glut of baby boomers turning 80 and older over the coming years will be […]

Why One ACO Wants to Send More Patients Directly to Skilled Nursing Facilities

The shrinking pool of Medicare patients has long been a source of worry for skilled nursing providers, who are battling shortfalls in revenue ranging from low state reimbursement to challenges in billing private insurance companies. In particular, accountable care organizations (ACOs) have come up over and over again as some of SNF operators’ key pain […]

CMS Expands Power to Ban Providers with ‘Problematic’ Affiliations from Medicare, Medicaid

The federal government on Thursday finalized a rule that will expand its power to remove potentially unscrupulous health care providers from Medicare and Medicaid eligibility. Under the new final rule, the Centers for Medicare & Medicaid Services (CMS) can kick providers out of the programs if they have a previous affiliation with a banned organization, […]

CMS Chief Medical Officer: More Changes Coming to Nursing Home Compare, Quality Measures

The past several years have seen sweeping overhauls of nursing home enforcement on the federal level, and the Medicare program’s top clinical officer says her agency isn’t done beefing up its efforts. Dr. Kate Goodrich, the chief medical officer for the Centers for Medicare & Medicaid Services (CMS), promised that more changes are coming to […]

Medicare Spends Significantly More on SNF Stays Than Private Plans — With No Clinical Difference

Commercial insurance payers spend significantly less on post-acute and skilled nursing care — with much shorter SNF stays — compared with Medicare fee-for-service reimbursements. But even though Medicare pays more for post-acute care and SNF stays, there are no significant differences in readmission rates — suggesting that there may not be any clinical benefits to […]

AHCA: CMS Already Has Authority to Simplify Three-Day Stay Rule for Nursing Home Coverage

The leading national trade group representing for-profit skilled nursing facilities this week called on the federal government to streamline its policy on Medicare eligibility for nursing home care, arguing that officials already have the legal authority to do so. American Health Care Association president and CEO Mark Parkinson formally asked Centers for Medicare & Medicaid […]

Verma: CMS Should Reduce Survey Frequency for Top Nursing Homes, Look Beyond Monetary Penalties

The leader of the Centers for Medicare & Medicaid Services (CMS) on Wednesday continued her public push for greater nursing home oversight, promising that the agency will use data to target states with suspiciously low rates of citations — while also expressing a desire to reduce survey frequencies for top performers. CMS administrator Seema Verma […]

Unpacking the New Therapy Contract Math for Skilled Nursing Providers Under PDPM

Faced with a sea change in the Medicare reimbursement system for nursing homes, operators have spent the last year asking a key question about their therapy offerings: outsource or in-house? And if the answer is outsource, what will that relationship look like moving forward in unfamiliar payment landscape? There’s no one correct answer for contract […]

Lorien, the ‘Nursing Home Company That Doesn’t Like Nursing Homes,’ Sees Home Services as Vital to Success

As the population of the United States ages, it’s becoming imperative for long-term care operators to come up with solutions to deal with the coming demographic wave — across a variety of settings. For Lorien Health Services — which offers a range of services from skilled nursing to assisted living to dialysis across nine facilities […]

Skilled Nursing Providers Could See Slight Changes in Value-Based Purchasing Penalties, Bonuses After CMS Error

Skilled nursing operators may notice some small changes to their final bonuses or penalties under a key value-based payment initiative after federal officials acknowledged a slight error in their calculations. The Centers for Medicare & Medicaid Services (CMS) on Thursday announced that it incorrectly calculated its scores for the SNF Value-Based Purchasing (VBP) initiative, according […]

Despite Pressures, ACOs’ Three-Day Stay Waivers Could Emerge as Skilled Nursing Secret Weapons

Among the new payment models sweeping the skilled nursing industry, accountable care organizations (ACOs) tend to vex nursing home operators the most. These groups, which encourage cost savings by holding providers up and down the continuum accountable for overall health spending, are typically seen as length-of-stay depressants. The hospitals and physician organizations that generally lead […]

Treating Depression Could Emerge as a PDPM ‘Linchpin’ — Both for Payments and Better Outcomes

Accurately diagnosing and treating depression could bring significant rewards for operators under the new Medicare payment model for nursing homes — both financially and clinically. Training frontline caregivers to notice the signs of depression among residents of skilled nursing facilities will be vital to success under the coming Patient-Driven Payment Model (PDPM), according to Zimmet […]