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) recently proposed Value-Based Purchasing Program updates include staffing provisions that are being met with provider concern, although other updates should be well received once the dust settles. Among recommended changes, CMS is proposing allowing SNFs to review and correct Payroll-Based Journal (PBJ) data beginning with the fiscal […]
The federal government’s proposed Medicare payment increase for 2025 is not sitting well with the nursing home sector, with financial experts and operators raising concerns that the bump fails to compensate for inflation-induced operating costs – and a staffing proposal anticipated to cost in the billions each year. For some experts, the Centers for Medicare […]
Soaring costs associated with skilled nursing – and problematic payer sources – are making it harder for continuing care retirement communities (CCRCs) to provide such labor intensive post-acute care. CCRCs have to ask themselves some hard questions when it comes to what services they can reasonably offer, and if it’s worth it to keep open […]
Piece by piece, nursing home operators are seeing stricter government oversight of Medicare Advantage (MA) plans, a welcome relief given that partnerships with such managed care plans have become a huge source of administrative burden for providers in the sector, especially as workforce shortages persist. Most recently, the Centers for Medicare & Medicaid Services (CMS) […]
Given that a vast majority of long-stay nursing home residents are dual eligible for Medicare and Medicaid, residents and facilities alike can reap financial benefits while improving quality of care and reducing administrative burdens if federal and state policies better enabled a value-based care model that integrated the experiences of dual eligibles. This is the […]
The need for Medicaid as stopgap coverage for long-term care is more apparent when looking at differences in race, gender and ethnicity, and rural versus urban status of the residents. This is according to an analysis conducted by ATI Advisory, which identified the impact of disparities and differences in resources – finances, insurance and social […]
As nursing homes grapple with a tough economic and labor environment – which has forced closures and created access issues – patient and nursing home advocates underscored the emotional toll of care, calling upon the federal and state governments to do more to address new and emerging generational challenges to care. Anne Tumlinson, founder of […]
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 […]
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 – […]
As the public health emergency (PHE) comes to an end on May 11, industry leaders point out that nursing home operators are still in pandemic recovery mode, and that adjusting to the old way of doing business will not be easy. The PHE was declared in response to the Covid-19 pandemic, and accompanied a wide […]
As Medicare Advantage continues to penetrate the nursing home market, leaders say that MA plans are depressing margins amid higher costs to run operations. This might lead some operators to contemplate closing, while others will be wiser to hire staff in designated roles to help them negotiate better rates – and exclusions – for managed […]
After years in which Medicare policy and Covid-19 drove more hospital referrals to home health, skilled nursing facilities recently have seen referrals surge, thanks to a variety of factors. Referral trends through January 2023 showed a jump in patients sent to the nursing home while at the same time rejection rates for home health agency […]
A Congressional advisory body on Wednesday put forth recommendations for closer assessment of nursing facility Medicaid payments, including whether they are sufficient to cover costs of care. The proposals could allow for a finer tuning of Medicaid rates and therefore could benefit the sector, as long as they do not put greater administrative costs and […]
As nursing home advocates continue to push for ending the 3-day hospital stay requirement, a recently released federal agency report on the use of these waivers by accountable care organizations (ACOs) showcases some of the benefits that they have brought to patients and providers. Use of waivers by ACOs for a 3-day stay did not […]
As the federal government pushes to get more beneficiaries on managed care, nursing home providers say the administrative burden associated with such clients is “extraordinary.” That’s according to Kim Majick, chief development officer at Carespring Health Care Management. A heavier administrative lift is set against a backdrop of dire staffing shortages, along with staffing minimum […]
Skilled nursing facilities consistently received a higher share of hospital discharges compared to home health care agencies towards the last quarter of 2021 and beginning of the first quarter of 2022, a shift from the home health trend in the early days of the pandemic. “There was a preference amongst just about everybody to send […]
The Centers for Medicare & Medicaid Services (CMS) has decided to take action on transitions in care – specifically Medicare Advantage (MA) plans diverting care to home health instead of skilled nursing – after years of skilled nursing industry and consumer feedback. CMS last month took steps to address the trend with a proposed rule […]
Loans and other types of financing through the Department of Housing and Urban Development (HUD) may be key to incentivizing operators to seek innovation, such as scaling the small home model in a meaningful way – but the program isn’t quite at that point yet. The National Academy of Sciences, Engineering, and Medicine (NASEM) report […]
While so many nursing home trends have been altered by the pandemic, one has interestingly stayed in line with pre-pandemic statistics: Medicare Advantage’s (MA) growth trajectory. MA is still expected to cover 52.9% of all Medicare beneficiaries by 2031, according to Fred Bentley, managing director at ATI Advisory. Bentley spoke about Medicare’s evolution and its […]
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