CMS Hints at Value-Based Program Consolidation, Gives Nod to I-SNP Success

Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure noted higher participation in value-based payment models like Institutional Special Needs Plans (I-SNPs) during a recent discussion with HealthAffairs, but also hinted that consolidation of such programs may be needed. “Too many models in too many places that aren’t coordinated with each other,” is how […]

Value-Centric Legislation Gives ACOs a Leg Up

Members of the U.S. House of Representatives this week introduced bipartisan legislation to strengthen Medicare’s value-based care models and accountable care organizations (ACOs), among other alternative payment models (APMs). Doctors, hospitals and other providers make up an ACO — the group coordinates care for Medicare patients while limiting extraneous services and preventing medical errors. The […]

SNF Operators Likely to Invest in Clinical Capabilities, Home Care Lines to Stay Competitive

The ultimate role skilled nursing facilities will play in the post-acute care continuum coming out of COVID-19 remains to be seen. Home-based care utilization has skyrocketed over the past year, partly due to favorable policies out of the Biden administration and shifting referral-source preferences. Meanwhile, most SNF operators continue to battle back from the sudden […]

Skilled Nursing Providers Getting Squeezed As More Patients Go to IRFs Amid Pandemic

During Covid-19, skilled nursing facilities have seen their admissions squeezed as more patients have gone straight from hospitals to their own homes for recovery. But more complex cases are also being diverted away from SNFs, toward inpatient rehabilitation facilities (IRFs) and long-term acute-care hospitals (LTACs). It’s a trend highlighted in an analysis from consulting firm […]

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 […]