The Centers for Medicare & Medicaid Services (CMS) explicitly pointed to the potential for therapy fraud under its old rules while rolling out its updated payment structure for nursing homes — and the head of a leading trade group says that’s a slap in the face to the industry. Mark Parkinson, president and CEO of […]
Admissions to skilled nursing facilities have declined in a manner consistent with a drop in inpatient hospital usage, according to the Medicare Payment Advisory Commission’s (MedPAC) most recent data book. That’s just one of the conclusions from the statistics, released last month by MedPAC — a non-partisan agency that advises Congress on Medicare issues. For […]
Early reactions to the finalized skilled nursing payment rules from the Centers for Medicare & Medicaid Services (CMS) are in, with one leading provider group issuing a stark warning about the days ahead. “While the skilled nursing profession welcomes a new payment model, we are concerned with the language in this rule about the Patient-Driven […]
The Centers for Medicare & Medicaid Services (CMS) on Tuesday finalized its skilled nursing payment updates for fiscal 2019, formally enshrining the Patient-Driven Payment Model (PDPM) and other changes in a final rule. Under the finalized proposal, the PDPM — which will see therapy payments based increasingly on the complexity of patients’ clinical needs, and […]
Less than a month after a New York Times story revealed concerns about insufficient nursing home staffing levels, the Centers for Medicare & Medicaid Services (CMS) handed out nearly 1,400 one-star reviews. Last week, when CMS updated its Five-Star Quality Rating System for nursing homes, 1,387 facilities received one-star ratings for staffing coverage, according to […]
While they don’t represent broad-based coverage for skilled nursing facilities, new proposed telehealth guidelines from the Centers for Medicare & Medicaid Services (CMS) have drawn praise from providers and groups that see the news as a sign of even wider coverage on the horizon. Under the proposed rule issued earlier this month, CMS would expand […]
The top executive at a skilled nursing and assisted living facility in Martinsville, Va., is soon to be out of a job — and he’s the one who signed the pink slip. Blue Ridge Village CEO Chris Oswald cut his own position in an effort to reduce costs amid lower reimbursements and lengths of stay, which […]
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 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 […]
The amount of skilled nursing residents covered by in-house insurance plans remains small, but the growth has been steady in just the last few years — and providers are beginning to stand up and notice. Still, starting an Institutional* Special Needs Plan (I-SNP) isn’t for every operator, and one consultant in the space says savvy […]
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 […]
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 […]
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 […]
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 […]
It’s 4 p.m. on a Friday evening, and a patient at an acute care hospital needs a referral to a skilled nursing facility. Even if the hospital has a phone-book-sized list of all the different providers in the area who accept a specific managed care health plan, the reality is much narrower. “Our care management […]
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 […]
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 […]
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 […]
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 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 […]