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 […]

Skilled Nursing Operators Can Find Success Under the ‘Quite Similar’ PDPM and I-SNP Models

The Patient-Driven Payment Model (PDPM) overhauled the way skilled nursing facilities are paid for their services to Medicare fee-for-service patients when it took effect last year – removing therapy as a driver of reimbursement and putting an emphasis on patient conditions. That gives it more than a passing resemblance to a lightning rod in the […]

CMS Confirms Some PDPM Claim-Processing Errors, Promises Fix by October

The federal government on Thursday acknowledged some errors in processing Medicare claims under the new payment system for nursing homes, promising to make a full correction by the start of its next fiscal year. The main issue has to do with the sequence of initial claim filings for Patient-Driven Payment Model (PDPM) reimbursements, the Centers […]

Rise of Data Could Bring More False Claims Act Cases, CMS Scrutiny to Skilled Nursing

Attend any conference geared toward long-term and post-acute health care operators, and you’ll hear a common thread: Data is king. In a landscape defined by value-based payment models such as Medicare Advantage plans and accountable care organizations (ACOs), investing in data analytics has become almost a prerequisite for success. If a given operator can prove […]

Verma: CMS’s Nursing Home Oversight Push More ‘Internal’ Amid PDPM Shift

Seema Verma on Tuesday laid out a sweeping plan for data-driven oversight and enforcement across the health care spectrum, and took a similarly broad view of her agency’s regulatory plans when directly asked about potential changes to the new Medicare payment model for nursing homes. Specifically citing the early success of the agency’s recent push […]

‘CMS Loves That’: Moderate Therapy Shifts, Bureaucratic Reality Could Slow PDPM Changes

Despite steady reports of increasing reimbursements under the new Medicare payment model for nursing homes, at least one industry leader believes that the federal government will be happy with the early returns — and that any changes are fairly far down the road. Skilled nursing operators have not gone overboard with the strategy changes that […]

With $5M Infusion, Home Health Staffing Startup Sees Skilled Nursing Opportunity Amid PDPM Upheaval

A health care staffing startup that had initially focused on the home setting sees significant opportunity to expand into a skilled nursing space still grappling with the implications of a new Medicare payment model — and it recently pulled down a $5 million funding round to help fuel that growth. The Los Angeles-based Gento, formerly […]

PDPM Layoffs Could Send Some Therapists to Home Health, But Former SNF Workers Not Targets

Both the skilled nursing and home health spaces are in the midst of shifts to new Medicare payment models, and despite widespread reports of therapy layoffs at nursing homes, a leading player in the home care space says it isn’t necessarily targeting the cohort of available therapists. Encompass Health Corporation (NYSE: EHC) has been monitoring […]

Omega to Divest Struggling Daybreak Skilled Nursing Portfolio, Cautiously Upbeat on Medicaid Crackdown

After multiple quarters of struggles with operator Daybreak Venture, Omega Healthcare Investors (NYSE: OHI) on Thursday announced a plan to largely purge the provider’s buildings from its portfolio. “During the course of the next several quarters, Omega anticipates transitioning, either through re-leases or sales, the vast majority of Daybreak’s existing Omega facilities,” chief operating officer […]

Ensign Rides High-Acuity Skilled Nursing Model to 6% Rate Gains Under PDPM

The Ensign Group (Nasdaq: ENSG) on Thursday announced that its skilled nursing facilities have seen rate increases of up to 6% under the new Medicare payment model, in part helping to drive the post-acute leader to another set of record earnings. The company’s established same-store facilities achieved those 6% gains, while Ensign’s transitioning facilities — […]