The Centers for Medicare and Medicaid Services (CMS) this week released the Minimum Data Set 3.0 quality measures user’s manual, with notable changes being far more sweeping than many in the sector expected. Two major updates involve the respecification of the long stay antipsychotic measure and a risk adjustor modification to the discharge function score […]
Achieving financial stability and growth in the current reimbursement environment is no small task for nursing home providers. Three particular challenges relate to value-based purchasing (VBP) program changes, effects of the One Big Beautiful Bill Act (OBBBA) and the continued rise of Medicare Advantage, leaders with Ignite Medical Resorts and ArchCare said during a recent […]
Pinnacle Multicare Nursing and Rehabilitation Center received overpayments exceeding $31.2 million, as a result of noncompliance with Medicare requirements under the Payment Driven Payment Model (PDPM), a federal watchdog group estimated in a report posted Tuesday. However, Pinnacle is countering that coding guidelines were misapplied and the audit failed to consider waivers in place during […]
By Kristin Carroll Skilled nursing facilities can leverage the Patient Driven Payment Model (PDPM) to provide more palliative care to people near the end of life, helping to drive value-based care goals while improving the patient experience. However, much more needs to be done on the policy level to disrupt the current status quo, in […]
Implementation of the Patient-Driven Payment Model (PDPM) significantly increased coding intensity among skilled nursing facilities, while Medicare expenditures grew by $665 per beneficiary on average, despite the model’s intended budget neutrality. Increased spending was observed especiallyamong patients with medically complex health care needs, according to a study published on Monday in JAMA Internal Medicine. Meanwhile, […]
Changing regulations and payment models, along with evolving resident preferences and acuity are pushing skilled nursing operators to grow and diversify therapy services in-house or with a partner. Outsourced therapy providers, in particular, have shifted their business model to focus more on clinical specializations and value-added services rather than volume. For providers of in-house therapy, […]
With overlooked reimbursement opportunities in the Payment-Driven Payment Model (PDPM) relatively common, nursing home operators can start to improve by focusing on some key areas where money is commonly left on the table. Accurate documentation in the areas of speech, non-therapy ancillary services and nursing are top of the list for improving reimbursement through the […]
A newly released study casts doubt on whether the shift to Medicare Patient Driven Payment Model (PDPM) succeeded in the goal of curbing so-called “upcoding” practices among nursing homes. Conducted by researchers from the University of Rochester and the University of Texas at Austin, the analysis spans seven years and found patterns of exploitation that […]
Delivering care to dual eligible nursing home residents can be complex with so many payers involved in the industry, but aligning incentives, quality measures and tools for providers can help operators serve this demographic. Dual eligible residents, or those that can receive benefits from both Medicare and Medicaid, often find themselves in a “tangled web […]
Quantity, by virtue of an aggressive growth strategy at PACS Group (NYSE: PACS), has not impacted quality at its facilities, executives said. In fact the opposite has been true, and the resulting quality gains are also one of the reasons for the company’s strong second quarter. The company’s model is based on successfully turning around […]
Meticulous documentation is the name of the game for nursing home operators looking to keep up with Minimum Data Set (MDS) changes and maintaining a good rating in the Five-Star Quality Rating System. This is especially because inaccurate or insufficient data could affect a facility for at least a year in the future. Leaders in […]
Over 200 nursing homes in New York have united in a legal challenge against the state’s Department of Health over alterations to Medicaid reimbursement formulas that they argue have unfairly deprived them of funding. The lawsuit centers on case-mix adjustments used to calculate Medicaid reimbursements based on the intensity of care. Traditionally recalculated every six […]
Amid plans to launch the largest provider-owned institutional special needs plan (I-SNP) in the U.S., Brickyard Healthcare is also making sure it surpasses certain other challenges facing the sector. Along with this endeavor, eliminating agency use, preparing for managed Medicaid in Indiana, and being ready to face the staffing mandate, have all been top of […]
The “super SNF,” an insider term used for nursing homes that serve mostly high acuity patients, is evolving to enhance its specialized function, and leaders in the space believe it will be a replacement – or at least a supplement – for long-term acute care hospitals (LTACHs) and inpatient rehabilitation facilities (IRFs). The latest changes […]
As nursing homes are still in the process of updating their procedures to align with October 2023’s MDS requirements, avoiding compliance and payment problems involves having accurate data, and it all begins with its collection. Data collection has become a tough exercise in the midst of staffing challenges, and many facilities have yet to update […]
Nursing homes and the state associations that represent them continue to put pressure on legislators to match Medicaid rates with rising costs, and change how often rebasing occurs to give operators a more even playing field. In a lot of cases, Medicaid increases helped lessen the gap between costs and stagnant rates. But, legislators still […]
Minimum Data Set (MDS) changes for 2024, along with updates to nursing home surveys were top of mind among representatives of the Centers for Medicare & Medicaid Services on Thursday, as the agency outlined its plans for next year in an Open Door Forum. CMS plans to release the MDS 1.19.1 in early 2024 with […]
In adjusting to new case-mix systems under the Patient Driven Payment Model (PDPM), the changes to reimbursement rates might be more widespread and large-scale than anticipated, posing financing threats to the nursing home sector because lenders are basing loans on rate projections that are expected to be scaled back. The goal of budget neutrality – […]
The past year or two have seen big wins in terms of increased Medicaid funding for nursing homes – a welcome relief as the sector faces staffing shortages amid a looming minimum staffing proposal, higher inflationary costs and rising acuity of resident needs. The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) […]
One of the unintended consequences of the minimum staffing proposal may mean less utilization of nursing homes as residents are shifted to other means of care – a trend spurred by an expanded use of Medicaid waivers. Policymakers may opt for these as a safety net for access issues among seniors, especially in rural settings, […]
