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 […]

Specialties, Complex Patients Get Boost Under New CMS Payment Model

Skilled nursing facilities that can serve more medically complex patients will be rewarded under the Centers for Medicare & Medicaid Services’ (CMS) proposed Patient-Driven Payment Model (PDPM), according to a new white paper from Integra Realty Resources’ health care and senior housing practice. The proposed model, announced late in April, draws from a previously proposed model, the Resident Classification […]

CEOs Upbeat About New CMS Skilled Nursing Payment Rules

Industry experts are still sorting out the long-term effects of the Centers for Medicare & Medicaid Services’ (CMS) new payment system for skilled nursing facilities, but early reviews from the CEOs of some top providers have been positive. “I would say the rule that was just published is a positive for the industry,” Genesis Healthcare […]

Proposed Medicare Change Would Create Long-Term Care Benefit

A federal lawmaker on Wednesday rolled out a plan to provide a long-term care benefit as part of Medicare, citing the aging U.S. population and skyrocketing costs. Rep. Frank Pallone, a New Jersey Democrat, unveiled the Medicare Long-Term Care Services and Supports (LTSS) Act, a discussion draft of a bill that would expand Medicare coverage […]

New Skilled Nursing Payment Plan Shows CMS Listened to Providers

The Centers for Medicare & Medicaid Services (CMS) shook the skilled nursing world last week by rolling out a proposal for a new payment model, replacing the structure that the industry had been anticipating for a year. But several experts say that operators should look at the changes as positive updates made with providers in […]

Managed Care Plans See Skilled Nursing as a Commodity, Not a Partner

Experts are increasingly calling on skilled nursing facilities to step up and tout their worth in the new value-based health care landscape. But skilled nursing facilities may not have that much influence to wield, particularly when it comes to the growing force of managed care, one expert says. “As an industry, SNFs have no leverage […]

Skilled Nursing Can Do It Cheaper, But Reputation and Partner Risks Remain

Skilled nursing facilities often bear the brunt of negative press surrounding long-term care, and their place in the future of the continuum could rest on changing that reputation in the minds of the public and lawmakers. “We need to get that reputation back, because we are part of the solution,” Celtic Consulting president Maureen McCarthy […]

Facilities Grab Increased Share of Hospital Discharges

Despite concerns about the rise of home health in the era of value-based care, institutional post-acute care (PAC) use among Medicare beneficiaries actually rose between 2000 and 2015 — while discharges to the home fell over the same time period, according to a research letter published in JAMA. Specifically, the adjusted percentage of nearly 138 […]

Long-Term Care Providers ‘Clobbered’ by Managed Medicare

While the skilled nursing industry worried about the rise of accountable care organizations (ACOs), managed Medicare plans slowly established a firm foothold that isn’t going anywhere soon. “The growth of ACOs and bundled payments has kind of leveled off,” Jill Kreuger, president and CEO of pharmacy and rehab solutions provider Symbria said at LeadingAge Illinois’s […]

As Managed Care Grows, Skilled Nursing Providers Have Leverage

Skilled nursing providers are adding value for managed care payors, and they need to be willing to tout it in contract negotiations, according to one executive. “[Managed care] is coming your way,” Anthony Laflen, director of data analytics at Consonus Healthcare, told a room full of nursing home operators at LeadingAge Illinois’ annual conference in Schaumburg, Ill. […]

Operators See Opening to Shape Managed Care Policy in States

Managed care is on the rise in both Medicare and Medicaid, but skilled nursing and long-term care (LTC) providers don’t necessarily need to play catch-up. In fact, they have room to influence the direction of managed care in their states, according to a panel at the National Investment Center for Seniors Housing & Care (NIC) […]

Former Long-Term Care CEO to Lead CMS Innovation Center

The Center for Medicare & Medicaid Innovation (CMMI) has a new director. Adam Boehler, founder and former chief executive officer of home health provider Landmark Health, was named CMMI director — a position that also comes with the title of deputy administrator — by Department of Health and Human Services Secretary Alex Azar. Azar has […]