Iowa Nursing Home Lobbyists Praise Lowered Fines Under Trump

Nursing home lobbyists in Iowa thanked federal regulators for lowering fines on facilities and asked them to “pursue a more collaborative — and less punitive — role” in nursing home regulation, the Des Moines Register reported Wednesday. In a July 7 phone call arranged by U.S. Sen. Charles Grassley, R-Iowa, Iowa Health Care Association (HCA) President Brent […]

Skilled Nursing Facilities Rank Low on Operators’ Investment Wish Lists

Skilled nursing facilities lag far behind home health and other long-term care settings among providers’ investment outlooks, according to a new survey of major health care providers. Just 12% of organizations surveyed by consulting and advisory firm BDO said they were making investments in skilled nursing care as part of their two-year plan to 2020 […]

Having an In-House Insurance Plan Could Signal PDPM Success

Some skilled nursing providers have turned to in-house insurance plans to take more control of the care process, and the move could pay off if the government’s new proposed reimbursement model is finalized. The Patient Driven Payment Model (PDPM), which the Centers for Medicare & Medicaid Services (CMS) proposed in April, would overhaul skilled nursing reimbursements […]

How Skilled Nursing Providers Can Win Under Value-Based Purchasing

Skilled nursing facilities have until October to prepare for the new Value-Based Purchasing (VBP) model, and the stakes are high: Starting this fall, SNFs will automatically lose 2% of their Medicare funding, which they can earn back by hitting certain key quality benchmarks. Providers that have already participated in risk-based accountable care organizations (ACOs) will […]

PDPM Could Create New Challenges for Skilled Nursing, AHCA Says

A newly proposed payment system overhaul for the skilled nursing industry could create new challenges for the sector, according to public comments by trade groups and other stakeholders submitted on the Federal Register. Namely, the American Health Care Association (AHCA) believes the payment system, as proposed by the Centers for Medicare & Medicaid Services (CMS) in […]

Despite Shorter Stays, Medicare Advantage Improved Skilled Nursing Outcomes

Patients enrolled in Medicare Advantage (MA) plans had a shorter rehabilitation stay in a skilled nursing facility and were more likely to be successfully discharged to the community, compared with patients on fee-for-service (FFS) Medicare, according to a new study published in PLOS Medicine. MA patients were also less likely to experience a 30-day hospital […]

Bundled Payment Lessons Still Relevant for Skilled Nursing Providers

In a post-acute landscape dominated by the rise of Medicare Advantage and the looming changes to therapy payments, the Bundled Payments for Care Improvement (BPCI) program has fallen somewhat by the wayside. That’s partially because post-acute providers — including skilled nursing operators and home health agencies — can no longer be episode initiators under the upcoming BPCI […]

Data Drives Skilled Nursing Referral Partnerships, But Residents Ignore It

As referral networks narrow and skilled nursing providers feel increased pressure to prove their worth to hospitals and doctors, one government agency says residents still frequently miss the highest-quality options in their own areas. In its most recent report to Congress, the Medicare Payment Advisory Commission (MedPAC) asserts that many hospitals discharge post-acute care patients […]

MedPAC Again Calls for Skilled Nursing Payment Cuts in Mixed PDPM Review

The Medicare Payment Advisory Commission (MedPAC) issued a mostly positive assessment of the new proposed payment rules for skilled nursing facilities, but the organization wants change to come faster than planned. Citing the similarity between the new Patient-Driven Payment Model (PDPM) and the now-shelved Resident Classification System, Version I (RCS-I), MedPAC asserted that the planned […]

Operators Report Rising Length of Stay Pressure Under New Payment Models

Skilled nursing facilities are feeling pressure from several fronts to discharge patients within a specified time to meet strict length-of-stay (LOS) goals, according to a study recently published in Health Services Research. Those include Medicare policy changes and market-based pressures, particularly from Medicare Advantage (MA) plans and hospitals participating in accountable care organizations (ACOs) and bundled […]

Signature HealthCARE to Pay $30M to Resolve FCA Claims Related to Rehab

Signature HealthCARE will pay more than $30 million to resolve allegations that it violated the False Claims Act (FCA) by knowingly submitting false claims to Medicare for rehabilitation therapy services. The settlement resolves allegations leveled in a lawsuit by Kristi Emerson and LeeAnn Tuesca, former Signature therapy employees, filed in federal court in Nashville, Tenn., and […]

What Bleak Medicare Predictions Mean for Skilled Nursing

The Medicare fund that helps pay for skilled nursing care is projected to run out of funds for full benefits three years sooner than predicted last year, according to a financial review by the Social Security and Medicare boards of trustees. The situation isn’t quite as dire as some headlines have made it sound (one […]

New Skilled Nursing Payment Model Raises Medicare Advantage Questions

Providers that have learned to navigate the Medicare Advantage ecosystem will likely have a leg up when approaching the new payment model for skilled nursing facilities, but many questions still remain about how managed care plans will adapt under the coming system. The Patient-Driven Payment Model (PDPM) reflects an ongoing push toward rewarding therapy providers […]

Azar Touts PDPM But Warns ‘Entrenched Players’ of Challenges Ahead

Health and Human Services Secretary Alex Azar on Tuesday trumpeted the new payment model for skilled nursing facilities in a speech before a prominent trade group, positioning the plan as one piece of a larger change in the way the government pays for health care. The new Patient-Driven Payment Model (PDPM) incorporates the dual goals […]

Therapy Providers Agree: PDPM Improves Upon Old Payment Models

A new survey of therapy providers found broad support for the new Patient Driven Payment Model (PDPM), with respondents citing it as an improvement over the Centers for Medicare & Medicaid Services’ (CMS) earlier attempts at payment reform. Specifically, the new survey of 134 therapy professionals — including a mix of contract therapy providers and skilled […]

Preferred Care Looks to Settle Lawsuits to Speed Up Bankruptcy

Embattled skilled nursing provider Preferred Care has asked a federal bankruptcy judge to approve a settlement regarding allegedly falsified Medicare and Medicaid claims. Settling the pair of federal whistleblower lawsuits, filed in 2016 and 2017, would help accelerate Preferred Care’s Chapter 11 bankruptcy process, the provider argued in a filing submitted last week. Westlaw Practitioner […]

Skilled Nursing Providers Need Steady Vision to Survive Value-Based Struggles

While skilled nursing operators have increasingly faced stresses related to the ongoing shift to value-based care — primarily the threat of decreased reimbursements — at least one observer says the industry hasn’t seen anything yet. “You’re just entering the value-based dynamic right now,” Mountasser Kadrie, a health care management consultant, said during a presentation at […]

Rehab Business Model Will Change ‘Substantially’ Under PDPM

Therapy companies that provide services to skilled nursing patients must radically change their business models if the Centers for Medicare & Medicaid Services’ (CMS) proposed Patient Driven Payment Model (PDPM) is finalized and takes effect next year. That doesn’t mean that rehabilitation services for skilled nursing facilities will go away. But under PDPM, providers will […]