Managed care’s growth across all health care settings, including nursing homes, has pushed reimbursement rates lower, and operators are implementing strategies to counter the situation.  For starters, operators expressed the need to be well equipped for negotiating better rates with managed care organizations (MAOs). And, coming armed with cost of care data to the negotiating […]

Operational and financial challenges can make it difficult for nursing homes and other health care facilities to transition to the federal government’s Value-Based Program (VBP), which ties payment to quality and outcomes. An editorial published in JAMA Internal Medicine Monday expresses the need for more data and improved measurement of outcomes, better methods of financial […]

The Centers for Medicare & Medicaid Services’ (CMS) in April released a bundled payment model that is the culmination of the best aspects from such past models, all to align with the agency’s efforts to get all Medicare Fee-for-Service beneficiaries involved in value-based care by 2030. The Transforming Episode Accountability Model, or TEAM, is considered […]

If there’s no additional funding for the minimum staffing rule, well over 5% of existing facilities will close, depending on how successfully operators can pivot to meet the standard. The rates of closure may even reach 10% to 15%, depending on the market, cautioned sector leaders attending the LTC100 conference this week. Steve Nee, CEO […]

The Centers for Medicare & Medicaid Services (CMS) is testing out a payment model that would cover all costs associated with an episode of care, including a skilled nursing stay, but it appears that select hospitals would be in the driver’s seat if approved. Certain surgical procedures will fall under the new model and include […]

The Centers for Medicare & Medicaid Services (CMS) on Friday issued its draft Minimum Data Set (MDS) — earlier than the federal agency’s typical timeline and with less sweeping changes compared to past years. Changes, effective Oct. 1, include an update to the list of state RAI coordinators, MDS automation coordinators, CMS locations and contacts, […]

The costs of long-term care in every setting, including nursing homes, is considered out of reach for most seniors, averaging more than $100 per day nationwide. This is coupled with the fact that the majority of older adults with very low incomes will need such services and have the fewest resources to pay for them. […]

As patient preference continues to shift away from nursing homes, public attention is increasingly on alternate modes of skilled nursing care as well, including continuing care retirement communities (CCRCs). Newsweek, for one, came out with a ranking of such communities in partnership with global market and consumer data firm Statista. The companies expect rankings to […]

Some physician groups have decided to join the accountable care organization (ACO) REACH programs to better serve high needs groups given that the nursing home sector is gravitating toward value-based care – the trend being especially true if patients are already aligned with an ACO through their primary care provider. Theoria Medical, for one, made […]

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 […]

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 […]

The latest proposed changes to the REACH accountable care organization (ACO) may make it even easier for skilled nursing facilities to be a part of an ACO program – and there may be implications for quality of care, industry leaders said. A broadened criteria and an attractive high needs population track is expected to be […]

The rise of managed care plans among nursing home beneficiaries has meant that nursing home providers have had to make tough choices to balance the pros and cons of such plans to reap profits. And, despite a proven track record of handling higher acuity, many providers may not think to use this to their advantage […]

A big question that operators must ask themselves when considering involvement in an institutional special needs plan, or I-SNP, is ultimately wrapped up in how much money is being made on the Medicare Part B therapy side, some say. It might not make financial sense to sign up for an I-SNP if a SNF operator […]

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 […]

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 […]

Following the Biden Administration’s bid this week to reduce the price of certain drugs – many of which are commonly used in nursing homes – experts are cautioning that the changes may negatively impact the bottomline of organizations in the sector. As Medicare Part D price negotiations for these drugs come into focus this week, […]

General staffing metrics used to assess quality of care hold less weight these days and need to be updated, experts say, because the entire skilled nursing industry is struggling to build and retain its workforce. These quality measures need to be presented through the lens of the pandemic and the staffing crisis, SNF leaders say. […]

Clinical staff in nursing homes can successfully improve care and reduce hospitalizations by virtually monitoring patients, according to a study on novel nurse-driven virtual care models released Tuesday. The qualitative study of remote monitoring models has implications for addressing staffing challenges at nursing homes without compromising patient care.  The Regenstrief Institute in Indianapolis implemented a […]

Value-based care program (VBP) measures proposed by the Centers for Medicare & Medicaid Services (CMS) have long loomed over skilled nursing operators, and now it seems more are finally on their way for 2026. Staffing-related measures, rehospitalization, discharge and infection prevention are all areas of focus for CMS’ proposed and finalized measures alike. Moreover, proposals […]