Private Equity Must Be Nimble, Innovative to Succeed in Skilled Nursing

Tempted by demographic trends and a new reimbursement system, private equity has taken a keen interest in the skilled nursing industry over the past year. But executives at these investment vehicles would be foolish to think they can plug their existing models into nursing home business and expect the same kind of success they may […]

Growth in Medicare Advantage Spending Far Outpaces Traditional Medicare

The growth in overall spending on nursing homes in the United States slowed for the second consecutive year in 2017, according to the latest analysis from the Centers for Medicare & Medicaid Services (CMS) — while Medicare Advantage spending skyrocketed. All payers spent $166.3 billion at nursing care facilities and continuing care retirement communities (CCRCs) […]

Trump Cabinet Calls on States to Eliminate Certificate of Need Laws

Three prominent members of the Trump administration called on individual states to eliminate Certificate of Need (CON) laws regarding the development of new health care facilities — including nursing homes — characterizing the statues as anti-competitive and detrimental to consumers. Writing in a sweeping, nearly 120-page report on health care reform, the secretaries of the […]

No Room for Error as Providers Update Rehab Contracts Under PDPM

When sitting down at the negotiating table, rehabilitation companies can often have an edge over the skilled nursing facilities where they provide services. This is especially true as providers take stock of their costs and care models in preparation for the new Medicare payment system taking effect next year. But that doesn’t mean that SNFs […]

Lessons from Medicare Cuts to Skilled Nursing Go Beyond Winners, Losers

At face value, the statistics look grim: Nearly three-quarters of the nation’s skilled nursing facilities will see pay cuts in 2019 under the government’s value-based purchasing (VBP) program after failing to reach mandated readmission benchmarks. But the numbers themselves don’t tell the full story, according to players in the long-term health care space. Based on […]

CMS to Cut Medicare Payments for 73% of SNFs Under Value-Based Purchasing

Nearly three-quarters of skilled nursing facilities will see Medicare reimbursement penalties after failing to hit certain readmission improvement benchmarks, according to a new set of data from the Centers for Medicare & Medicaid Services (CMS) Of the just under 15,000 facilities that reported sufficient data, 73% — or nearly 11,000 buildings — had incentive payment […]

Speech Therapy Poised to Take Center Stage in Skilled Nursing Under PDPM

Among the potential upsides and pitfalls under the new Medicare payment system for skilled nursing facilities, one specialty comes up consistently as an area of great opportunity: speech therapy. When the new Patient-Driven Payment Model (PDPM) takes effect next October, speech therapy will play a greater role in a resident’s overall care plan than under […]

CMS to Use Provider Fines to Develop Nursing Home Safety Resources

The Centers for Medicare & Medicaid Services (CMS) on Tuesday announced an initiative to divert some of the money it collects in provider fines to fund general nursing home improvement initiatives. The three-year Civil Money Penalty Reinvestment Program (CMPRP) will use a portion of nursing home penalty cash to pay for the development of toolkits […]

Aegis CEO: Therapy Can Still Drive Skilled Nursing Revenue Under PDPM

The new Medicare payment model for skilled nursing facilities upends the old system of rehabilitation minutes driving reimbursement. With the Patient-Driven Payment Model (PDPM) scheduled for implementation on Oct. 1, 2019 by the Centers for Medicare & Medicaid Services (CMS), SNFs and therapy providers alike are scrambling to catch up and prepare. In this changing landscape, […]

Formation Chairman: New Models for Skilled Nursing are Emerging

Formation Capital has a long history in skilled nursing and based on our conversation with Arnold Whitman — its founder and chairman — the company continues to see a big opportunity for the industry to take advantage of the shift to value-based care. During the National Investment Centers for Seniors Housing & Care (NIC) conference in […]

Barriers Between Financial, Clinical Staff Must Come Down Under PDPM

Providers’ early reviews of the new Patient-Driven Payment Model (PDPM) have been largely positive, but operators also only have around 11 months to develop the kinds of internal protocols necessary to maximize reimbursements — and success could hinge on getting various players within a single facility to agree with each other. In Leah Killian-Smith’s experience […]

Maryland Provider Reaches $2M Settlement Over False Discharge Claims

An extended battle between a now-defunct nursing home operator and the state of Maryland reached a conclusion this week with a $2.2 million settlement. Neiswanger Management Services (NMS) agreed to pay that amount to dismiss allegations that it had improperly discharged Medicare residents and falsely billed the state’s Medicaid program, Maryland Medical Assistance. Back in […]

CMS Moves to Expand Telehealth Coverage Under Medicare Advantage

The Centers for Medicare & Medicaid Services on Friday unveiled a proposal that the agency says will expand telehealth coverage to enrollees in Medicare Advantage plans. Under the proposed rule, which would take effect in calendar year 2020, Medicare Advantage plans could cover telehealth services for both rural and urban enrollees, as well as in-home […]

Medicare’s Impending Death Greatly Exaggerated, But Concerns Remain

Despite concerns about its impending doom, the financial outlook for the Medicare program has improved considerably from where it was 10 years ago. That said, Medicare remains an extremely expensive program, Alicia Munnell and Anqi Chen, both of the CRR, noted in a research brief published last week. “U.S. health care costs as a percentage of […]

Discharges to Skilled Nursing Remain Steady, But Home Health Gains Ground

Hospitals continue to discharge a fairly consistent share of their patients to skilled nursing facilities, but home health has seen a spike in admissions amid a shifting reimbursement landscape and changing consumer preferences. Acute-care hospitals released 22% of their patients into skilled nursing facilities during the first quarter of 2018, according to data released Wednesday […]

Skilled Nursing Providers Have One Shot at Payment Success Under PDPM

Of all the changes coming to the skilled nursing industry when a new payment model takes effect next fall, the most pressing may be one of the most basic: Starting in October 2019, providers will have a single opportunity to set themselves up for financial success with a patient’s initial assessment. The Patient-Driven Payment Model, […]