Bundled Payments Cost Medicare Nearly $300 Million

A new report on the Bundled Payments for Care Improvement (BPCI) program found that the initiative has actually resulted in Medicare losses, counter to its aims. Under BPCI, providers agree to split a set reimbursement amount for a patient’s single episode of care, with the overall goal of reducing costs across the spectrum. But in […]

OIG Wants to Revise Anti-Kickback Rules to Ease Care Coordination

As the federal government increasingly emphasizes care coordination among players across the health care continuum, the industry’s top watchdog signaled that it could soon overhaul its anti-kickback regulations to help providers avoid pitfalls. The Department of Health and Human Services’ Office of the Inspector General (OIG) this week published a call to providers, asking for […]

CMS Finalizes New Skilled Nursing Payment Rules, Predicts $820M Funding Boost

The Centers for Medicare & Medicaid Services (CMS) on Tuesday finalized its skilled nursing payment updates for fiscal 2019, formally enshrining the Patient-Driven Payment Model (PDPM) and other changes in a final rule. Under the finalized proposal, the PDPM — which will see therapy payments based increasingly on the complexity of patients’ clinical needs, and […]

CMS Hits 1,400 Nursing Homes with One-Star Reviews Over Staffing Concerns

Less than a month after a New York Times story revealed concerns about insufficient nursing home staffing levels, the Centers for Medicare & Medicaid Services (CMS) handed out nearly 1,400 one-star reviews. Last week, when CMS updated its Five-Star Quality Rating System for nursing homes, 1,387 facilities received one-star ratings for staffing coverage, according to […]

New Skilled Nursing Payment Plan Shows CMS Listened to Providers

The Centers for Medicare & Medicaid Services (CMS) shook the skilled nursing world last week by rolling out a proposal for a new payment model, replacing the structure that the industry had been anticipating for a year. But several experts say that operators should look at the changes as positive updates made with providers in […]

CMS Overhauls Skilled Nursing Payment Plan, Increases Rate by $850 Million

The Centers for Medicare & Medicaid Services (CMS) on Friday unveiled a new proposed model for skilled nursing reimbursements that the agency says will save providers $2 billion over the next decade. The proposed Resident Classification System, Version I (RCS-I) is out, and the Patient Driven Payment Model (PDPM) is in, with an effective start […]

HHS, CMS Object to Ownership Transfers in Orianna Bankruptcy

The Department of Health and Human Services (HHS) filed an objection to Orianna Health Systems’ bankruptcy plan, bringing the case into unsettled legal terrain. U.S. Attorney Erin Nealy Cox this week argued that HHS and the Centers for Medicare & Medicaid Services (CMS) have the ultimate control over the legal issues surrounding the transfer of […]

Former Long-Term Care CEO to Lead CMS Innovation Center

The Center for Medicare & Medicaid Innovation (CMMI) has a new director. Adam Boehler, founder and former chief executive officer of home health provider Landmark Health, was named CMMI director — a position that also comes with the title of deputy administrator — by Department of Health and Human Services Secretary Alex Azar. Azar has […]

High Five-Star Ratings Don’t Correlate with Lower Rehospitalization Rates

While individual star ratings are important for skilled nursing providers, a high number doesn’t always mean they are providing the best care and seeing lower rehospitalization rates. As the skilled nursing industry continues to adapt to new value-based care models, the importance of the Five-Star Quality Rating System from the Centers for Medicare & Medicaid […]

OIG: More Than 60% of Therapy Claims Don’t Meet Medicare Requirements

More than 60% of outpatient therapy claims filed over a six-month period didn’t meet Medicare’s requirements — a figure that has a key government watchdog agency concerned. The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) looked at a representative sample of 300 Medicare therapy claims filed in the final […]

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 […]

HHS Secretary Wants Providers to Take Amazon, Yelp’s Lead

If Health and Human Services secretary Alex Azar has his way, the health care consumer of the future will select providers the way they currently decide where to eat or which knockoff iPhone charger to buy. “Imagine a day when health care delivery in the United States functions the way other parts of our economy […]

Industry Responds to Democrats’ Call for Skilled Nursing Scrutiny

In a Valentine’s Day letter to top health officials, a group of influential Senate Democrats asked the Centers for Medicare & Medicaid Services (CMS) to reconsider certain rollbacks of nursing home regulations. In response, a leading industry group on Wednesday wrote back to the senators to clarify and rebut some of their points. “We think […]

Assuming Risk Key to Medicare Savings Under New Payment Models

Accountable care organizations (ACOs) only generate savings for the government if they accept risk, according to an analysis from the Kaiser Family Foundation. ACOs generated net savings of $47 million in 2016, the Menlo Park, Calif.-based non-profit found in an independent analysis of publicly available ACO data and previously unpublished numbers from the Centers for […]

Democrats Ask CMS to Halt Skilled Nursing Regulatory Rollback

A group of 12 Democratic U.S. senators slammed the Centers for Medicare & Medicaid Services in a letter sent last week, claiming that its leadership’s decision to ease regulatory restrictions on nursing homes has put seniors in danger. “We write with deep concern over a string of actions by the Centers for Medicare & Medicaid […]

Spending on Nursing Care to Increase Steadily Through 2026

Annual expenditures on skilled nursing care will increase by 3.9% this year and keep rising through 2026, according to a new study from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary. This rise in nursing home spending tracks with overall gains in outlays for health care services: Between 2017 and 2026, […]

HHS Proposes New Payment System for Skilled Nursing Providers

The new proposed Department of Health and Human Services (HHS) budget was released on Monday, and it’s a mixed bag for skilled nursing providers. President Trump’s spending blueprint would make changes to Medicaid by creating a “market-based health-care grant” that could fund programs in addition to the traditional Medicaid program — a change that would […]

Therapy Cap Repeal Part of House, Senate Budget Bills

Both the House and the Senate proposals to keep the government open and funded include a repeal of the controversial cap on Medicare-funded therapy services. Long opposed by the skilled nursing and physical therapy industries, the rule placed a $2,010 cap on therapy services for Medicare recipients. While Congress had routinely granted exemptions to the caps, those […]