Despite the challenges, skilled nursing facilities have succeeded at setting up their own specialty Medicare Advantage plans — and the strategy represents a key potential weapon amid the rise of alternative payment models. Institutional Special Needs Plans (I-SNPs) remain a small part of the overall Medicare Advantage landscape, according to a panel discussion at the […]
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, […]
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 […]
Skilled nursing operators frequently bemoan the shorter lengths of stay and lower daily payment rates for Medicare Advantage residents, but the leader of one plan says it’s also up to providers to present novel ideas to insurance executives. Before taking the CEO role at the nursing-home focused Longevity Health Plan earlier this year, René Lerer […]
The number of skilled nursing providers interested in becoming insurers has grown for the past several months. Now hard numbers show just how great that interest is. Special needs plans are a category within Medicare Advantage (MA) that provide a common framework for the plans that serve special-needs beneficiaries, while also expanding beneficiary choice and […]
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 […]
Among the many skilled nursing landmines — from a new Medicare payment system to underfunded Medicaid programs to a shifting regulatory landscape — providers would be wise not to ignore the ongoing effects of bundled payment programs. In fact, at the end of a recent discussion on his research into the cost-savings successes and failures […]
Ever since the government came out with its most recent model for bundled payments, acute care has been in the driver’s seat. Under the Bundled Payments for Care Improvement Advanced (BPCI Advanced) program, hospital providers and physician leaders are the only ones who can initiate episodes of care. The Centers for Medicare & Medicaid Services […]
For many skilled nursing providers, the launch last week of the 2020 application period for the government’s flagship bundled-payment program was low on the list of priorities. After all, under the new Bundled Payments for Care Improvement Advanced (BPCI Advanced) model, nursing homes can’t be episode initiators, meaning hospitals and other acute-care providers are the […]
The Centers for Medicare & Medicaid Services (CMS) this week announced a 2.5% boost to overall Medicare Advantage payment rates — but the news isn’t likely to bring relief to skilled nursing operators struggling with low MA reimbursements. That 2.5% rate gain in 2020 represents a bigger gain than the 1.59% increase that the agency […]
It’s an existential problem that many providers face in the skilled nursing industry: New payment models demand substantial operational changes, but the current fee-for-service reality determines how they can pay and plan for those shifts. This frustrating dichotomy was on full display during a panel discussion on Institutional Special Needs Plans (I-SNPs) and other new […]
The second episode of our podcast, Rethink, is now available! From the federal government to Avalere Health to the advisory firm that bears her name, Anne Tumlinson has been a leading voice on the business of long-term health care in the United States. As CEO of Anne Tumlinson Innovations, she hears from providers around the […]
Medicare Advantage plans have emerged as one of the strongest pressures on skilled nursing occupancy and margins in recent years, and operators have scrambled to find any possible way to adapt. Many have found reason for optimism in calls to embrace data analytics as the key to survival: Prove your worth to Medicare Advantage plans […]
As Medicare Advantage plans continue to pressure skilled nursing operators, one prominent leader in the space predicts that innovative providers can survive by leaning into the changes. By transforming their facilities into standalone medical-surgical facilities that can replace similar units in hospitals, SNFs can evolve into purely short-stay health care providers that thrive in the […]
It’s been a common refrain in the industry: To survive in a health care system increasingly moving to value-based payment models, skilled nursing facilities will have to form strong partnerships with hospitals, health systems, and accountable care organizations (ACOs). But doing that will be difficult if acute care facilities and ACOs aren’t interested in forging […]
SNN presents this guest analysis from Anne Tumlinson and Elizabeth Walsh of Anne Tumlinson Innovations. Health care providers selling Medicare Advantage (MA) products isn’t a new trend, but typically “providers” refers to hospitals, health systems, or physician groups. Few would expect nursing homes and assisted living operators to be able or willing to manage health care […]
Skilled nursing providers have faced pressure to break into area hospitals’ top-tier referral groups — the increasingly select few deemed fit to manage acute care operators’ patient populations across the continuum. But when SNFs size up their competitors in their marketplaces, are they facing off for a slot in a hospital’s top five, or top […]
Admissions to skilled nursing facilities have declined in a manner consistent with a drop in inpatient hospital usage, according to the Medicare Payment Advisory Commission’s (MedPAC) most recent data book. That’s just one of the conclusions from the statistics, released last month by MedPAC — a non-partisan agency that advises Congress on Medicare issues. For […]
Experts are increasingly calling on skilled nursing facilities to step up and tout their worth in the new value-based health care landscape. But skilled nursing facilities may not have that much influence to wield, particularly when it comes to the growing force of managed care, one expert says. “As an industry, SNFs have no leverage […]
The skilled nursing world is in upheaval, but too many providers are complacently running the skilled nursing facility of yesterday rather than creating a successful model for the future. That’s according to Anne Tumlinson, founder of consultancy Anne Tumlinson Innovations and a nationally recognized authority on post-acute and senior care. She previously led Medicaid oversight […]
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