PDPM Adjustments, Smaller Medicare Raise Show CMS ‘Ready to Pull Back’ on COVID Aid to Nursing Homes

As the federal government’s approach toward nursing homes and COVID-19 continues to shift from emergency support to reflection and reform, analysts are increasingly warning that the coronavirus-era gravy train could soon come to an abrupt stop. In particular, the past week has brought three pieces of news that may signal trouble ahead for operators and […]

CMS to Adjust PDPM ‘As Quickly as Possible’ Amid Evidence of $1.7B Nursing Home Payment Increase

The federal government is mulling several options to recalibrate the Medicare payment structure for skilled nursing facilities as it seeks to achieve its intended goal of budget neutrality — with the aim of shutting off excess payments sooner rather than later. The Centers for Medicare & Medicaid Services (CMS) this week determined that the Patient-Driven […]

Therapy Staffing Dropped Up to 10% at Nursing Homes in Wake of PDPM — Mostly Through Contract Cuts

Therapist staffing coverage at nursing homes fell up to 10% after the October 2019 implementation of a new Medicare payment model, a new study has determined — with the cuts coming primarily on the backs of contracted employees and not full-time skilled nursing facility staffers. Physical and occupational therapist staffing was 6% lower in the […]

To Get Ahead of PDPM Audits, Skilled Nursing Facilities Target Top Areas of Payment Focus

When the overhaul of Medicare Part A reimbursement for nursing homes took effect in October 2019, predictions of audits and the potential for drastic changes came close on its heels. After all, the Patient-Driven Payment Model (PDPM) was meant to be revenue-neutral, meaning that the Centers for Medicare & Medicaid Services (CMS) would not spend […]

Managed Care Companies Take Lead on PDPM Denials — But CMS Could Step Up Scrutiny During 2021

Over the course of 2020, as skilled nursing facilities battled the COVID-19 pandemic, the Patient-Driven Payment Model (PDPM) was one of the bright spots for operators, allowing them to secure payments for caring for the clinical needs of patients at a time when those needs grew markedly more complex. The Centers for Medicare & Medicaid […]

A Year into PDPM and Many Months into COVID, Respiratory Therapy Waits for ‘Industrywide Embrace’

When the Patient-Driven Payment Model (PDPM) overhauled the way Medicare reimburses care provided in skilled nursing facilities, the federal government attempted to put the focus on the care needs of patients — and in doing so, incentivized facilities to capture patient conditions more thoroughly and add to their clinical specialties. At least, that was the […]

CMS ‘Quiet’ on PDPM-Related Enforcement Even as Rates Rise, But Managed Care More Prone to Denials

The Patient-Driven Payment Model (PDPM), the overhaul to Medicare reimbursement for skilled nursing facilities that took effect in October of 2019, has proven its worth as a mechanism for paying for nursing care during a global pandemic. It has, however, been “anything but revenue-neutral,” at least in terms of how much money the government is […]

Almost a Year After PDPM’s Implementation, Providers Still Miss Key Payment Drivers

In the months leading up to the implementation of the Patient-Driven Payment Model, the overhaul of Medicare reimbursement for skilled nursing facilities that was implemented last year, several factors emerged as crucial areas for thriving under the new system. The Medicare rate of each facility is determined by a formula that draws from five care […]

Fresh Off Private Equity Pickup, Wound Care Provider AMT Seeks Skilled Nursing Expansion

A leading wound care provider sees expansion opportunity in both skilled nursing and the home despite the ongoing strains of COVID-19, with a recent private equity investment to back it up. American Medical Technologies in late August announced its acquisition by private equity firm One Equity Partners and investment management company The Silverfern Group, capping […]

Isolating COVID-19 Patients Critical for Nursing Home Safety — But PDPM Hasn’t Caught Up

The infectious nature of COVID-19 makes it imperative that skilled nursing facilities take extra precautions around any new admissions that they bring in, as well as any residents that are returning from a hospital stay. According to the Centers for Disease Control and Prevention (CDC), the procedure for SNFs is straightforward: Keep any COVID-19-positive patients […]

Though Data on Outcomes Sparse, CMS Han’t Forgotten PDPM Monitoring — While Wage Index Drops Loom

The Centers for Medicare & Medicaid Services (CMS) has been slow to make moves on audit demonstrations for the Patient-Driven Payment Model (PDPM), the Medicare reimbursement overhaul for skilled nursing facilities that took effect last year. But that doesn’t mean that the agency has forgotten its promise to closely monitor patient outcomes and scrutinize SNFs’ […]

COVID-19 Scrambles PDPM Math, Particularly Around Therapy Minutes: ‘This Will Be a Complete Rebuild’

In the lead-up to the implementation of the Patient-Driven Payment Model (PDPM) on October 1, 2019, consultants, therapists, and the federal government warned operators over and over that therapy minutes would come under intense scrutiny in the months following the start of the new Medicare reimbursement system. The model allowed for patients to receive up […]

Skilled Nursing Facilities to See 2.3% Medicare Raise — or $784M — Under Fiscal 2021 Proposed Rule

The federal government late Friday released its proposed rule for skilled nursing facility payments for the coming fiscal year, which will see the nation’s nursing homes receive a 2.3% Medicare pay bump. “This estimated increase is attributable to a 2.7% market basket increase factor with a 0.4 percentage point reduction for multifactor productivity adjustment,” the […]

Researchers Find ‘Perverse Incentives’ for Skilled Nursing Operators Under PDPM

The new Medicare payment model for nursing homes was designed to eliminate the temptation to make key care decisions based solely on reimbursements, and not on individual residents’ needs. Though the early results from the Patient-Driven Payment Model (PDPM) have largely been positive for the industry, a group of researchers this week raised concerns about […]

After PDPM, ‘More Than Half’ of Therapists Report Mandate to Provide Group, Concurrent Therapy

The Patient-Driven Payment Model (PDPM) was specifically designed to reimburse skilled nursing facilities based on the condition of the patients that they treat, rather than by the minutes of therapy provided to those patients. As part of the change, the Centers for Medicare & Medicaid Services (CMS) included a 25% cap on group and concurrent […]

Diversicare ‘A Very Different Company’ After Kentucky Exit, Touts 7.5% Medicare Rate Boost

Despite a net loss for the quarter, skilled nursing operator Diversicare Healthcare Services (OTCQX: DVCR) touted its performance at the end of 2019, pointing to a 7.5% Medicare rate boost and generally positive performance under the new Patient-Driven Payment Model (PDPM). “With our portfolio changes behind us after the Kentucky exit and the implementation of the new […]