Medicare Advantage’s Strength During COVID-19 to Drive Expansion into New Markets, 50% Adoption by ’24

While the skilled nursing landscape continues to struggle both operationally and financially during the COVID-19 pandemic, those same negative forces have only served to strengthen private health plans — putting Medicare Advantage in an even better position to continue its growth. Cratering census and sharp declines in elective surgeries, while fiscally devastating for nursing homes, […]

While Hospital Discharges to Home Health Rebound, SNFs See ‘Drastic and Lasting Decline’

The COVID-19 pandemic pummeled patient volumes across the health care continuum, but for skilled nursing facilities, the sharp decline in patients has not rebounded, according to a new analysis — even as hospitals and home health see their admissions recover. Discharges to SNFs and to the home health setting fell in tandem with the decline […]

CMS Move to Delay Elective Surgeries Could Create Lasting Strain on Skilled Nursing Facilities

Skilled nursing facilities, and post-acute providers in general, will feel pain even beyond the immediate short-term challenges of protecting residents and staff from the spread of the novel coronavirus, several experts predicted Thursday. The Centers for Medicare & Medicaid Services late on Wednesday recommended the delay of “all elective surgeries, non-essential medical, surgical, and dental […]

Payment Outlook: 60% of MA Plans Cover Telehealth, 95% of Post-Acute Providers Subject to Alternate Models

The new fee-for-service Medicare model absorbed much of the oxygen around nursing home payment reform in 2019, but 2020 — as well as the years beyond — will bring a slew of alternate payment pressure to the post-acute sector. Over the next two years alone, 95% of post-acute operators will find themselves in new payment […]

Why 2020 Could Be the Year of PDPM Exits — and the Skilled Nursing-Led ACO

The consulting firm Avalere Health, based in Washington, D.C., has had a front-row seat for the changes shaping the health care world, including the post-acute sphere. For skilled nursing facilities, many of those changes have felt like one punch after another, ranging from the rise of Medicare Advantage enrollment to the federal government’s encouragement of […]

Rethink Podcast #20: Fred Bentley of Avalere Health

The 20th episode of our podcast, Rethink, is now available! The Patient-Driven Payment Model — and all the changes that came with it — officially arrived for skilled nursing providers in October 2019. The new Medicare reimbursement system for SNFs was top of mind throughout the year, but 2020 will bring a variety of new challenges, […]

Mixed Skilled Nursing Projections for 2020: Increased Demand, But Margin Pressure Continues

Increasing demand for skilled nursing services is a good sign for the industry, according to several experts who spoke on SNN’s annual outlook webinar, but a continued squeeze on margins may affect some facilities’ ability to keep their doors open in 2020.  Although the Patient-Driven Payment Model (PDPM) looks like good news, with increased reimbursements […]

Rapid Medicare Advantage Expansion into Home Health, Senior Living Could Accelerate Pressures on Skilled Nursing

When the Centers for Medicare & Medicaid Services (CMS) moved to allow Medicare Advantage plans to cover more options for care at home, skilled nursing providers could be forgiven for not paying much attention. It’s a move with more immediate impact to home care and home health companies, as well as senior living providers. Medicare […]

CMS Shares Strategies for Successful Collaborations Between ACOs, Nursing Homes

The federal government released a breakdown of strategies that accountable care organizations (ACOs) have used to successfully partner with skilled nursing facilities — a move that could indicate policymakers’ continued support of the care models. The Centers for Medicare & Medicaid Services (CMS) recently released a care coordination toolkit for ACOs that drew from focus […]

Savings Success in ACOs Takes Time, and Risk Might Not Matter

Accountable care organizations (ACOs) need time to work out their growing pains before producing savings for the government, according to a new study from a top health care consulting firm — and a major assumption about risk might not actually be true. ACOs active for four years or longer accounted for just about all of […]

When Hospitals Build Skilled Nursing Networks, How Narrow is Too Narrow?

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 […]

Specialized Skilled Nursing Operators to Benefit from New CMS Payment Model

The new Patient-Driven Payment Model (PDPM) for skilled nursing facilities will require a strategic shift away from the volume of services provided to a focus on patient needs, and a new analysis from Avalere Health says providers should start breaking down their patient data now in order to adapt. Some providers could see Medicare reimbursements decrease […]

Medicare Advantage Beneficiaries Do Better On Outcomes, Costs

Patients enrolled in Medicare Advantage programs outperformed traditional fee-for-service (FFS) on several key quality measures, according to a new report from Avalere. MA beneficiaries in Avalere’s study had 23% fewer inpatient stays and 33% fewer emergency room visits than FFS Medicare beneficiaries. MA beneficiaries received more preventive physician tests and services, while FFS Medicare beneficiaries […]

Two-Sided Risk Key to Telehealth’s Promise in Skilled Nursing

Telehealth has promise for long-term care facilities in rural areas, but a new risk model may be needed to fully realize the technology’s potential, according to testimony at a hearing before the U.S. House Ways and Means Committee that focused on innovation in health care. Rep. Adrian Smith, a Nebraska Republican, noted the significance of […]

Instead of Saving $1.7 Billion, ACOs Cost Medicare $384 Million

Accountable care organizations (ACOs) are supposed to represent an innovative way to cut costs and improve care. But a new study found that on at least one of those counts, ACOs may be doing more harm than good. The Medicare Shared Savings Program (MSSP) increased federal spending by $384 million between 2013 and 2016, according […]

Skilled Nursing Operators Fighting for Share of Shrinking Medicare Pool

The number of skilled nursing stays among Medicare recipients dropped 15% over the last several years — but not necessarily for the reason many in the industry might believe. Instead of lower-cost options like home health cutting into demand for nursing home services, the post-acute sector in general is seeing declines amid an overall drop in […]

Two Visions of the 21st Century Skilled Nursing Facility

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 […]