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 […]
Nursing homes in Pennsylvania face a critical underfunding of Medicaid, with one in four nursing home beds currently offline due to inadequate reimbursement. Survey findings from LeadingAge PA also point toward the continuing workforce shortage, as to why so many beds are not in use. About 48% of facilities in the state have had to […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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