As PDPM Nears, Providers Can’t Rely on Sunny CMS Projections to Succeed

As the implementation date draws nearer for the overhaul of the Medicare reimbursement system, some providers have found comfort in government projections about their revenue under the new model. But that comfort might be misplaced, according to a webinar held Wednesday by Minneapolis.-based consulting and management firm Health Dimensions Group. The Centers for Medicare & […]

CMS Hints at ‘Calling Out’ Nursing Homes Over Quality Problems

A Centers for Medicare & Medicaid Services (CMS) official last week suggested that the public would benefit from more information about resident safety at nursing homes — including the explicit identification of bad actors. Writing in response to a November study about the correlation between Nursing Home Compare star ratings and safety, CMS chief medical […]

Provider in $1.5M Skilled Nursing Settlement Responds to ‘Inaccurate’ Government Claims

Management at Conway Lakes Health & Rehabilitation in Orlando this week struck back at the federal government’s claims of malfeasance, days after regulators announced a $1.5 million settlement deal to resolve allegations of illegal kickbacks. The Department of Justice accused Clear Choice Health Care, the operator of Conway Lakes, and its employees of giving improper […]

More Winners Than CMS Expects Could Emerge Under PDPM

The government has predicted a mix of winners and losers under the new Medicare payment model taking effect later this year. But due to the impact of payment changes on provider behavior — both past and future — there could end up being more winners under the new system than regulators expect. Specifically, under the […]

CBO: Nursing Homes Account for 15% of All Medicaid Spending as Aging Population Drives Costs

Programs for Americans aged 65 and older will account for nearly half of all the federal government’s non-interest spending in the next decade, a new report from the Congressional Budget Office found, as the baby boom population continues to age into both Medicare and certain Medicaid benefits. Medicare, Medicaid, and Social Security spending will balloon […]

Orlando Skilled Nursing Facility, Executives to Pay $1.5M to Resolve Federal Kickback Allegations

The operator of an Orlando skilled nursing facility, along with several executives and a third-party doctor, earlier this month agreed to pay $1.5 million to settle federal allegations of an illegal kickback scheme. Federal prosecutors accused the Melbourne, Fla.-based Clear Choice Health Care, operator of the Conway Lakes Health & Rehabilitation facility, of paying doctor […]

PDPM Creates New Litigation Risk for Skilled Nursing, Rehab Providers

After years of facing governmental and legal scrutiny over providing too many rehabilitation hours, both skilled nursing and therapy providers will soon find themselves with the completely opposite risk. As the Patient-Driven Payment Model (PDPM) shifts incentives away from the volume of therapy hours, providers could find themselves accused of not providing enough rehabilitation time […]

AllyAlign CEO: I-SNPs Will Form ‘Permanent Pillar’ in Changing Skilled Nursing World

The exponential growth of Medicare Advantage (MA), with its lower reimbursements and greater length-of-stay pressure, has been a thorn in the side of many skilled nursing providers. As part of a bid to wrest back control, SNFs are increasingly looking to become insurance providers, driving the growth of individualized Medicare Advantage options as they move […]

Focus on PDPM Could Distract Skilled Nursing Operators from Current Risks

With a new payment model just eight months away, the skilled nursing industry has trained a laser-guided focus on maximizing patient outcomes and reimbursements under the system. But smart providers would be wise not to let the Patient-Driven Payment Model (PDPM) distract them from the pressing issues facing them between now and October 1. “Any […]

ICD-10 Coding Will Be Crucial Under PDPM — But SNFs Don’t Need to Become Experts

The Medicare payment model taking effect on October 1 this year represents a sea change for skilled nursing providers in that patient condition, rather than therapy minutes, will drive reimbursement. It also represents a sea change in the mechanics of reimbursement. Under the Patient-Driven Payment Model, ICD-10 codes will form the basis of reimbursements, making […]

MedPAC Unanimously Calls for $2 Billion in Skilled Nursing Payment Cuts in 2020

After floating a proposed recommendation to slash nursing homes’ Medicare reimbursements for fiscal 2020, a leading legislative voice on health care issues made it final last week. The Medicare Payment Advisory Commission (MedPAC) called on Congress to reduce funding for skilled nursing facilities by up to $2 billion in the next fiscal year, citing sufficient […]

CMS Again Moves to Expand Telehealth Coverage Under Medicare Advantage

The federal government on Friday unveiled a series of new test benefits that certain Medicare Advantage plans can offer, including expanded telehealth coverage — marking yet another push toward remote health care benefits. The Centers for Medicare & Medicaid Services (CMS) will implement the programs under the Value-Based Insurance Design (VBID) model, which seeks to […]

Skilled Nursing Industry Split on Whether PDPM Will Boost or Cut Revenues

Leaders from multiple segments of the post-acute and long-term care industry have expressed optimism about increased reimbursements under the new Patient-Driven Payment Model (PDPM), but a survey of Skilled Nursing News readers revealed a much murkier picture. In the month of December, SNN asked our readership — which includes executives and other leaders at operators, […]

Despite Speech Push, Physical and Occupational Therapy Have Key Role Under PDPM

Speech therapy has taken center stage in discussions about the new Medicare payment system for skilled nursing facilities, but therapists and operators say providers can’t ignore physical and occupational therapy services as they adapt. In the months after the Centers for Medicare & Medicaid Services (CMS) announced the new Patient-Driven Payment Model (PDPM), speech therapy […]

CMS Spells Out Expanded Skilled Nursing Waiver Requirements for ACOs

The Centers for Medicare & Medicaid Services (CMS) provided details this week on what accountable care organizations (ACOs) have to do to receive waivers of the three-day inpatient stay requirement for skilled nursing care in updated guidance. ACOs consist of hospitals, physicians, and other health care providers that band together to provide care to Medicare […]

Why Skilled Nursing Providers Could Embrace Shorter Lengths of Stay

As Medicare Advantage plans continue to pressure skilled nursing operators, one prominent leader in the space predicts that innovative providers can survive by leaning into the changes. By transforming their facilities into standalone medical-surgical facilities that can replace similar units in hospitals, SNFs can evolve into purely short-stay health care providers that thrive in the […]

Without Incentive to Share Savings, ACOs Add to SNFs’ Financial Headaches

It’s been a common refrain in the industry: To survive in a health care system increasingly moving to value-based payment models, skilled nursing facilities will have to form strong partnerships with hospitals, health systems, and accountable care organizations (ACOs). But doing that will be difficult if acute care facilities and ACOs aren’t interested in forging […]

Bundled Payments Save Money ‘Nearly Exclusively’ By Cutting Skilled Nursing

A key mandatory bundled payment program saved the government money almost entirely through the reduction of skilled nursing facility reimbursements, a new study from researchers at Harvard University concluded. Between 2016 and 2017, the Comprehensive Care for Joint Replacement (CJR) bundled payment model resulted in spending reductions of $1,084 per episode, the team concluded; after […]

Looking Ahead to the Top Skilled Nursing Trends of 2019

We’ve made it to the end of 2018, which will likely go down as one of the most eventful years in the history of the long-term and post-acute care industry. Between the first round of Value-Based Purchasing penalties taking effect and the rapid rollout of the Patient-Driven Payment Model (PDPM), it’s probably a safe bet […]