After 50 Years, PruittHealth Looks to the Future with I-SNP — and Staff Development Strategies from Disney

PruittHealth spent 2019 celebrating its 50th anniversary in the post-acute and long-term care space, but second-generation CEO Neil Pruitt, Jr. says his company — along with the rest of the industry — must focus on novel and creative strategies for surviving into the future. Pruitt sees potential in a variety of forward-thinking initiatives, from the […]

CMS to Have ‘Limited’ Survey Capacity for New Nursing Home Requirements of Participation

Confusion continues to reign over the final set of new requirements for Medicare- and Medicaid-certified nursing homes, as the federal government disclosed that it will have very little ability to enforce the rules until the middle of next year. The third and last update to the Requirements of Participation (RoPs) is set to take effect […]

Nursing Home Dialysis Demand Drives Post-PDPM Push to Specialty Services

Dialysis services have recently been highlighted as a major growth area under the new Patient Driven Payment Model (PDPM) — both financially and clinically — especially as reimbursements are recalibrated for higher acuity patients. In July, the Centers for Medicare & Medicaid Services (CMS) rolled out the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) model, […]

Skilled Nursing Admissions Drop Across the Country as Home Health Discharges Pull Ahead

In another sign of the shifting paradigm in post-acute care, home health agencies beat out the skilled nursing setting as the most likely post-acute referral destination — while SNF admissions dropped in all 50 states from last year. That’s according to the 2019 Industry Trend Report from Trella Health, which analyzes Medicare Part A and […]

Record-Setting Nursing Home Fraud Case Ends in $44M Judgment

The former nursing home owner behind the largest criminal health care fraud case in U.S. history had already received a 20-year prison sentence, but a federal judge on Thursday added a $44 million payment to the punishment. Philip Esformes, who once ran a skilled nursing facility and assisted living chain with locations from Miami to […]

Early PDPM Claims Data Reveals Far More Winners Than Losers, ‘Impossible Combinations’ of Conditions

The first round of claims data under the new Medicare payment model for nursing homes shows that the majority of operators are seeing reimbursement boosts — while some are also making key billing mistakes that could result in missed payments for certain services. The average skilled nursing facility saw Medicare reimbursements of $614.96 per patient […]

Looming 8% Cut to Therapy Payments Could Have ‘Major Impact’ on Residents, Operators

There’s been significant attention focused on the potential for therapy reductions and reimbursement shifts amid the transition to the Patient Driven Payment Model (PDPM) on October 1, but concerns may soon be shifting to another looming therapy change — this time under Medicare Part B. The Centers for Medicare and Medicaid Services (CMS) has proposed […]

Some Medicare Contractors Holding Up Claim Payments Amid the Shift to PDPM

Some of the private insurance companies that process Medicare claims on behalf of the federal government are holding up claims for skilled nursing facilities after the implementation of the Patient-Driven Payment Model (PDPM) in October. But it’s not clear how widespread that is, BKD director John Harned and senior managing consultant Sherri Robbins said on […]

Moody’s: PDPM Has Potential to Stabilize Rents for Skilled Nursing REITs

Skilled nursing facilities will become more financially stable under the new system for Medicare reimbursement – which is a good sign for their landlords, according to Moody’s. Specifically, the stabilized cash flows under the Patient-Driven Payment Model (PDPM) are set to improve real estate investment trusts’ (REIT) credit standing, allowing more investments in this sector, […]

PDPM Therapy Changes, Staff Reductions to Bring Genesis $30M in Annual Savings

Prior to the advent of the new Medicare payment model for skilled nursing facilities, Genesis HealthCare (NYSE: GEN) CEO George Hager predicted that his company would see expense reductions of 12% — primarily through an increased emphasis on group and concurrent services. So far, at least according to Hager, the company has come through on […]

Omega Looks to Cut Daybreak Skilled Nursing Exposure After Performance ‘Deteriorated Further’

Despite showing long-term optimism about Daybreak Venture, executives at Omega Healthcare Investors (NYSE: OHI) on Wednesday revealed an ongoing plan to replace the struggling skilled nursing operator at many of its facilities in Texas. The two parties have mutually agreed to work toward a deal that would “selectively downsize” Daybreak’s footprint across the Lone Star […]

How Has Your Skilled Nursing Company Adapted to PDPM? Take Our Survey Today

Stories of therapist layoffs and shifting care strategies rocked the skilled nursing world at the start of this month, when the new Patient-Driven Payment Model (PDPM) took effect. Now that the industry has logged a full month under the overhauled Medicare payment model, Skilled Nursing News wants to know how your organization has adapted to […]

As Medicare Advantage Plans Slowly Migrate from RUG to PDPM, Providers Must Avoid Lost Payments

Most Medicare Advantage (MA) plans that used the old Medicare system for calculating reimbursement for skilled nursing facilities are moving to the new system along with the federal government — at least if the early weeks of the Patient-Driven Payment Model (PDPM) are anything to go by. That said, details on contracts and changes are […]

US News Focuses on Resident Complaints, Staffing in New Set of Nursing Home Ratings

U.S. News & World Report on Tuesday released its 2019-2020 Best Nursing Homes ratings, which the publication has pitched as a more consumer-friendly alternative to the Centers for Medicare & Medicaid Services’ (CMS) Nursing Home Compare website. Analysts from the national news outlet have moved away from CMS’s five-star ratings to rely on their own […]

I-SNP Case Studies Show Promise in Era Where Fee-for-Service Medicare Looks Unsustainable

Despite the challenges, skilled nursing facilities have succeeded at setting up their own specialty Medicare Advantage plans — and the strategy represents a key potential weapon amid the rise of alternative payment models. Institutional Special Needs Plans (I-SNPs) remain a small part of the overall Medicare Advantage landscape, according to a panel discussion at the […]

Push to Reduce Antipsychotic Drugs in Nursing Homes May Have Boosted Costly Hospitalizations

The regulatory push to reduce antipsychotic drugs in nursing homes may be correlated to a rise in risk factors for avoidable and non-avoidable hospitalization among residents with behavioral health issues, according to a recent study published in JAMDA, the journal for The Society for Post-Acute and Long-Term Care Medicine. A team of researchers from the […]

Bill Would Expand Nursing Homes’ Access to Federal Background-Check Database

A new piece of legislation before Congress would expand nursing homes’ ability to perform detailed background checks on potential employees, according to its sponsor. Sen. Kirsten Gillibrand, a New York Democrat, earlier this week announced a bill to improve health care worker hiring practices in an effort to reduce elder abuse. The initiative — known […]

Less Than 5% of Nursing Homes Receive Abuse Icon — But Financial Impacts Could Be Coming

As the federal government predicted, just under 5% of the nation’s nursing facilities received a new abuse warning icon on the consumer-facing Nursing Home Compare website — but the early data also reveals significant regional variations that could have an impact on valuations and bottom lines moving forward. Out of 15,262 total facilities, just 760 […]