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Therapy Cuts Were ‘Inevitable’ Under PDPM — and Providers Must Prepare for Possible Payment Drops

Reports of therapist layoffs and cuts in therapy hours hit the news within days of the implementation of the new Medicare reimbursement system for skilled nursing facilities, sending shock waves throughout the rehab provider community. But according to one major skilled nursing trade group, the cuts to therapy were baked into the system of the […]

Each Medicare Advantage Plan Can Treat PDPM Differently — and SNFs’ Mileage Will Vary

Skilled nursing providers looking for a simple answer to how managed care plans will react to the new Medicare payment model will likely have to face an inconvenient truth: It’s complicated. Private Medicare Advantage insurers didn’t have to follow the old Resource Utilization Group (RUG) model when deciding how to reimburse for skilled nursing services, […]

It’s Here: Skilled Nursing Providers, Investors Weigh in on PDPM Opportunities, ‘Stumbling Blocks’

The long wait is over: The new Medicare payment system for nursing homes has arrived. October 1 marks the official start of the Patient-Driven Payment Model (PDPM), just about 18 months after the federal government first announced the change in April 2018. Since then, the skilled nursing industry has trained a laser focus on preparations […]

Unpacking the New Therapy Contract Math for Skilled Nursing Providers Under PDPM

Faced with a sea change in the Medicare reimbursement system for nursing homes, operators have spent the last year asking a key question about their therapy offerings: outsource or in-house? And if the answer is outsource, what will that relationship look like moving forward in unfamiliar payment landscape? There’s no one correct answer for contract […]

Treating Depression Could Emerge as a PDPM ‘Linchpin’ — Both for Payments and Better Outcomes

Accurately diagnosing and treating depression could bring significant rewards for operators under the new Medicare payment model for nursing homes — both financially and clinically. Training frontline caregivers to notice the signs of depression among residents of skilled nursing facilities will be vital to success under the coming Patient-Driven Payment Model (PDPM), according to Zimmet […]

Under PDPM, Benefits of In-House Medicare Advantage Plans Will Go Beyond Money

Forward-thinking skilled nursing providers have increasingly warmed to the idea of starting a special kind of in-house Medicare Advantage plan in order to take more control over their reimbursements in an uncertain environment. But the strategies that operators must adopt to succeed with Institutional Special Needs Plans (I-SNPs) also fit seamlessly into preparations for the […]

Respiratory Therapy’s ‘Massive’ Skilled Nursing Opportunity Under PDPM

As providers continue to stare down the October 1 implementation of a new Medicare payment model for nursing homes, specialization remains at the top of many operators’ to-do lists — with respiratory therapy potentially emerging as a key revenue source. Because the Patient-Driven Payment Model (PDPM) matches reimbursements with resident acuity, operators have looked to […]

PDPM Countdown: ‘We Are All Crossing Our Fingers and Knocking on Wood’

With the Medicare Part A reimbursement overhaul taking effect in just a few months, skilled nursing providers across the country are in countdown mode. But the clock is moving at different paces for different providers, several experts said. Some SNFs began their analysis and preparations months ago; others are barely getting started. That’s led to […]

As PDPM Looms, Providers Must Balance Desire to Boost Payments with Audit Dangers

Under the Patient-Driven Payment Model (PDPM), reimbursement for Medicare Part A patients in skilled nursing facilities will be driven by patient condition, rather than by therapy minutes provided to that patient. It’s a change that the industry has hailed as an opportunity to receive financial credit for the care that they’re already providing, but they […]

PDPM Could Create Risk-Sharing Opportunities, Headaches for Skilled Nursing

Risk-sharing has loomed large in health care reform efforts over the last decade, and the new Medicare payment model for skilled nursing facilities could open up additional avenues for operators to take control — along with pointed questions from partners along the spectrum. The Patient-Driven Payment Model (PDPM) marks a step toward a long-teased site-neutral […]

Skilled Nursing Dealmakers Could Be Overlooking PDPM’s Potential for ‘Biggest Year’ in Decades

The market will still need to determine whether the new Medicare reimbursement structure for nursing homes will be a net positive or negative for the industry, but at least one insider says buyers and sellers in the space aren’t optimistic enough. Current prices for skilled nursing facilities don’t typically account for the potential of cost […]

Under PDPM, Providers Should Expect Close Scrutiny of Nursing Records

The new Medicare model for skilled nursing facilities more closely links reimbursements with resident conditions — and making sure that facilities completely document those conditions will soon be an essential step for success. But because payment under the current Resource Utilization Group (RUG) system is driven primarily by therapy minutes, capturing those conditions on the […]

Genesis’s PDPM Math: 12% Expense Savings, Shift to Fixed-Cost Therapy Contracts

Once the new Medicare payment model for nursing homes takes effect this fall, skilled nursing giant Genesis HealthCare (NYSE: GEN) expects to see significant expense savings — while also changing the way it negotiates therapy contracts with its third-party clients. The Kennett Square, Pa.-based operator projects that the expanded opportunity for group and concurrent therapy, […]

PDPM Goes Beyond Therapy: Finding the Hidden Value in Skilled Nursing Ancillaries

At surface level, the new Medicare payment model for nursing homes revolves largely around therapy, as the federal government works to realign incentives and prevent what officials claim to be a wave of unnecessary services. Speech, occupational, and physical therapy account for three of the five components of the Patient-Driven Payment Model (PDPM), and providers […]