Nursing Home, CCRC Spending To Reach $337B by 2032, as Insurance Enrollment Reaches New Heights

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 & […]

‘Custodial Care Rates’: Avamere, FPACP, LeadingAge Execs on Mitigating Headaches Tied to Medicare Advantage Plans

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 […]

Nursing Home Leaders from Genesis, Ignite, Diakonos, Avamere On Why ‘Super SNF’ May Replace Hospital-Based Recovery Care

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 […]

TEAM Model: Hospitals in the Driver’s Seat, Nursing Homes as ‘Collaborators’ in Latest Bundled Payment Initiative

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 […]

Greater Nurse Practitioner Presence Linked To Fewer Hospitalizations, Higher Hospice Use for Nursing Home Residents With Dementia

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 […]

LTC100 Panelists Weigh in on CMS Staffing Rule’s ‘Bloodbath’, Growth Strategies, and Risk-Based Model Reimbursement

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 […]

Medicare Advantage Growth Could Normalize, but Nursing Home Leaders Call for Rate Floor and Other Changes

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 […]

Even in States with Medicaid Increases, Nursing Home Closures Pile Up

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 […]

[UPDATED] CMS Proposes 4.1% Increase to Medicare Payments, While Expanding Monetary Penalties

The Centers for Medicare & Medicaid Services (CMS) issued its proposed rule that updates Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility Prospective Payment System for fiscal year 2025. CMS also proposed to expand the penalties that can be imposed through regulatory revision to allow for more per instance […]

‘Borderline Useless’ CMS Data Needs an Overhaul, Starting with the Addition of Medicare Advantage to Cost Reports

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 […]

Aldersbridge CEO: Tone Deaf Policy, MA Giants Have Backed Nursing Homes into a Corner

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 […]

‘Money Out of Our Pockets’: $274.9M in Nursing Home Revenue Lost For Every Percentage MA Plans Grow

As Medicare Advantage continues to grow in the skilled nursing space, beneficiaries utilizing traditional Fee-For-Service Medicare have declined, and in turn reimbursement has dropped at an alarming rate. For every two beneficiaries that opted for MA, one FFS individual left the program in 2023, the first year the number of FFS beneficiaries declined in every […]

Sabra’s Matros Says No ‘False Guardrails’ Around M&A Pipeline, Potential Skilled Nursing Deals

The year ahead for Sabra Health Care REIT (Nasdaq: SBRA) presents a “terrific” opportunity for improved margins and potential dealmaking, with eyes on multiple asset classes, according to Sabra CEO Rick Matros. While the California-based real estate investment trust (REIT) has focused in the past couple years on diversifying its portfolio – namely adding behavioral […]

HDG: How Hospitals, Nursing Homes Can Minimize ‘Headwinds’ From Policy Oversight of Medicare Advantage Plans

As nursing homes and hospitals confront lingering concerns with inpatient backlogs, lengths of hospital stay, and tighter operating margins, the growth of Medicare Advantage plans – and now greater scrutiny over their prior authorization protocols by the federal government – will only serve to squeeze profits margins. “So those are additional headwinds that will benefit […]

‘Elephant in the Room’: Medicare Advantage a Huge Factor in CCRC Decision Making Around Nursing Home Services

Soaring costs associated with skilled nursing – and problematic payer sources – are making it harder for continuing care retirement communities (CCRCs) to provide such labor intensive post-acute care. CCRCs have to ask themselves some hard questions when it comes to what services they can reasonably offer, and if it’s worth it to keep open […]

Big Players in Medicare Advantage, Cigna and HCSC, Involved in Planned $3.3B Deal 

As Medicare Advantage becomes an increasingly important – and controversial – payer for skilled nursing services, operators should note a major shift has occurred in the insurance landscape. Cigna Group (NYSE: CI) agreed Wednesday to sell its Medicare businesses and CareAllies to Health Care Service Corporation (HCSC). HCSC said it intends to acquire the Cigna […]

Inside the CMS Policies That Could Improve Care, Payments for Dual-Eligible Nursing Home Residents

Given that a vast majority of long-stay nursing home residents are dual eligible for Medicare and Medicaid, residents and facilities alike can reap financial benefits while improving quality of care and reducing administrative burdens if federal and state policies better enabled a value-based care model that integrated the experiences of dual eligibles. This is the […]