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Physician Groups Have Skilled Nursing Opportunity in PDPM — If They Take Action

The clinical condition and medical complexities of skilled nursing patients will drive reimbursement under the new Medicare system — giving physician groups that serve skilled nursing facilities the opportunity to have a major impact on the outcomes and success of both the patients and the facilities they serve. But it’s an opportunity they’ll have to […]

CMMI Could Put Post-Acute Providers Back in Control of Bundled Payments

The leader of the federal government’s center for reimbursement innovation said he is considering bundled payment models where post-acute care providers could take the lead on care — but right now it’s only at the consideration stage. Adam Boehler, who leads the Center for Medicare and Medicaid Innovation (CMMI), said that there has been significant […]

‘Unreasonable’ to Think Therapy Patterns Won’t Change Under PDPM

Though experts and federal authorities alike stress that the coming change to Medicare reimbursement shouldn’t affect the levels of rehabilitation provided to skilled nursing patients, the reality is that therapy is likely to evolve. That makes it all the more important for operator to clearly tie any changes in therapy provision to clinical needs and […]

Providers Can’t Lose Sight of ‘Where the Money Is’ Under PDPM

When it comes to the changes coming to Medicare reimbursement methodology, coding figures prominently in the discussion among skilled nursing providers. But while it’s important for SNFs to make sure staff education and training on that topic is up to date, there are several other components of reimbursement under the Patient-Driven Payment Model (PDPM) that […]

Only 32% of Skilled Nursing Providers Feel Clinically Ready for PDPM

As they get ready for the Medicare Part A reimbursement system taking effect October 1, skilled nursing providers have a high degree of confidence in the preparedness of their interdisciplinary teams. But that confidence plummets when assessing the preparedness of their clinical teams, according to a new survey from the Plano, Texas-based Reliant Rehabilitation. The […]

Timely, Regular Doctor Visits Could Reduce Readmissions at Nursing Homes

]With the increased premium placed on preventing rehospitalizations from skilled nursing facilities, timely interventions from a doctor can potentially make a major difference. Between 2012 and 2014, about 10.4% of residents did not see a physician at all during their time in the skilled nursing facility, according to a study published Monday in the journal […]

PDPM 101: What Skilled Nursing Providers Need to Know Now

With a new Medicare payment model for skilled nursing facilities just months away, operators who haven’t started planning for the changes are already months behind. Skilled Nursing News has been reporting on the new Patient-Driven Payment Model (PDPM) since the day it was announced last July 31, and we’ve spent those eight months speaking to […]

Cain Bros.: Gap Between Haves and Have-Nots in Skilled Nursing Could Widen

Pressured by already light coffers and razor-thin margins, skilled nursing facilities could see an even wider gulf grow between top and bottom performers under the new Medicare payment model. That’s at least according to Cain Brothers director Taaha Shaikh, who this week wrote a commentary calling the coming Patient-Driven Payment Model (PDPM) “the next great […]

Shorter Stays Bring Rewards Under PDPM — But Only to a Point

Skilled nursing providers might be able to reap financial gains under the new Medicare payment model taking effect in October of this year if they can cut their average patient length of stay (LOS). But the gains will only hold until a certain point, and providers that already have shorter LOS —- such as short-term […]

Crackdown on Improper Medicare SNF Payments May Cost More Than It Saves

The Department of Health and Human Services (HHS) made a splash last month when it claimed that skilled nursing facilities received $84 million in Medicare payments for treatments that didn’t qualify — but now a group of doctors claims that the proposed cures might be worse than the disease. Writing in a blog post for […]

Amid Changes, Downstream Partnerships Will Become Vital to Skilled Nursing Quality

Skilled nursing facilities are facing increasing pressure to be more aware of the full spectrum of a patient’s care, with the rise of value-based purchasing (VBP) programs and accountable care organizations. And when the new Patient-Driven Payment Model takes effect on October 1, that won’t be possible if individuals are making decisions on their own. […]

Scrutiny About Behavior Changes Under PDPM Will ‘Inevitably’ Come to Skilled Nursing

The changes in Medicare reimbursement taking effect in October will mean upheaval in more places than a skilled nursing facility’s billing department. It will mean changes in the nuts-and-bolts processes of patient care, and SNFs need to be preparing for this reality — with the knowledge that regulators will be watching closely. That’s according to […]

Deadline for SNFs to Dispute Value-Based Penalties Nears — But Some Claims May Be Too Old

Skilled nursing facilities officially have until the end of March to submit corrections related to their quality measure information under the SNF Value-Based Purchasing (VBP) program, which offers incentive payments for facilities that reach certain readmission benchmarks — as well as penalties for those that fail. But it might not be possible to complete the […]

Doctors, Software, Training: Preparing for ‘Non-Negotiable’ PDPM Coding Pressures

Starting October 1, skilled nursing facility operators will have no choice but to become proficient with a specific type of medical coding that previously had no bearing on reimbursements — and leading industry voices say there are multiple paths to getting there. ICD-10 codes, specific diagnosis identifications long used by hospitals, will play a key […]

PDPM’s Effects Could Stretch Far Beyond Medicare for Skilled Nursing Facilities

On paper, the Patient-Driven Payment Model (PDPM) will only affect one pillar of the payment equation for skilled nursing facilities. But as players start to unpack the coming rule changes, PDPM’s reach begins to extend far beyond Medicare. Medicare Advantage and Medicaid frequently base rate calculations on the existing Medicare structure, a pair of experts […]

MedPAC Again Calls for $2B in SNF Cuts, But Also Urges Caution Amid PDPM Shift

The Medicare Payment Advisory Commission (MedPAC) on Friday again called for up to $2 billion in cuts to skilled nursing reimbursements under Medicare — but with a caveat that the new payment model could cause significant changes for operators moving forward. The nation’s more than 15,000 skilled nursing facilities should not receive a scheduled 2.6% […]