Closing the Medicaid Gap Is Just the First Step, as Nursing Homes Fight for Predictable Reimbursement

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 […]

Dealmaking In Nursing Homes: Bubble Will Burst As States Aim for Budget Neutrality During Medicaid Recalibration

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 – […]

Nursing Homes Must Advocate for Medicaid Increases, as States Work En Masse to Rebase Rates

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) […]

How Medicaid Waivers Have Affected Nursing Home Utilization – And Why the Staffing Proposal May Further This Trend

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, […]

CMS Finalizes Physician Fee Schedule, with ACO Changes Relevant to Nursing Homes

The Centers for Medicare & Medicaid Services (CMS) aims to further advance its overall value-based care strategy with the finalized 20224 Medicare Physician Fee Schedule (PFS) – adding ways for medically complex, high-cost beneficiaries like those in nursing homes to participate in Medicare Shared Savings Programs (MSSPs). Additionally, CMS therapy assistants can be more generally […]

CMS Clarifies MDS Mood Interview Changes in RAI Manual Updates

More guidance is available on how to conduct mood interview changes, with the Centers for Medicare & Medicaid Services (CMS) updating the Resident Assessment Instrument (RAI) manual to reflect key changes in the new Minimum Data Set (MDS). Notably, if a resident refuses or is unwilling to participate in the interview, assessors need to go […]

Broken Alignment Between Physicians, Nursing Homes Must Improve for Value-Based Care Era

The way physicians and nursing home organizations work together must improve, especially with value-based care continuing to grow in prominence among all care settings. More specifically, C-suite executives, nursing staff and other leaders – from both the physician group side and nursing home operator end – must have a close partnership and aligned business strategies […]

Nursing Home Providers Exasperated with Vendor Issues, Error Codes in MDS Transition

Nursing home operators expressed frustration with Minimum Data Set (MDS) changes effective Oct. 1, with many concerned that they will be out of compliance with completion and submission requirements because of error codes. Errors are stemming from software vendors, and providers are unable to submit MDS data with proper coding information, nursing home operators said […]

Resident Voice Remains Main Focus of MDS Changes, As Nursing Home Providers Adjust and Educate

More than a week after updates to the Minimum Data Set (MDS) went into effect, each section change seems to be emphasizing focus on the resident’s voice, which along with substantial coding changes – four years in the making – will require time to incorporate, experts said. Kevin Cezat, director of clinical excellence for Therapy […]

Why Additional VBP Funding for Nursing Homes May Be More Trouble Than Gain

Nursing home operators participating in a value-based purchasing program (VBP) might be able to derive greater benefits in coming years from higher scores based on new measures, as the federal government seeks to reward organizations who prioritize health equity, among other factors. Joel Van Eaton, EVP of post-acute care regulatory affairs and education at Broad […]

Flu, Discharge Function Top of Mind as CMS Updates SNF Quality Reporting Program Manual

The Centers for Medicare & Medicaid Services (CMS) this week updated the SNF Quality Reporting Program (QRP), with changes to specifications used to calculate quality measures effective on Oct. 1. In terms of measures slated for removal from QRP, CMS doesn’t address how these gaps will impact requirements for reporting in its latest update, Jessie […]

Medicare Advantage Linked to Less Favorable Outcomes, Reduced Post-Acute Care Use 

As managed care plans become more and more relevant to the nursing home industry, it appears Medicare Advantage beneficiaries are experiencing less favorable outcomes, while using less post-acute care services than those on traditional fee-for-service Medicare. A study published in JAMA Health Forum on Friday suggests that MA enrollees reported less functional improvement while using […]

Sabra CEO: Reimbursement Hikes May Be Even Bigger Next Year to Account for Inflation 

Nursing home occupancy continues to slowly improve, a trend that along with higher reimbursement rates going forward, will improve the bottom line for Sabra Healthcare REIT (Nasdaq: SBRA), according to executives. Rick Matros, CEO of Sabra, said during the company’s second quarter earnings call on Tuesday that he expects a large increase to next year’s […]

While More is Needed, Operators are ‘Generally Pleased’ With 4% Increase in SNF Final Rule

Nursing home operators had a mixed reaction to the Centers for Medicare & Medicaid Services (CMS) final payment rule for 2024. While some operators said that they were generally appreciative of the 4% increase in Medicare reimbursement, they are also calling for more help and understanding from federal agencies in tackling the workforce crisis – […]