Top Trends That Will Shape the Skilled Nursing Sector in 2024

Margins squeezed by interest rates and inflation, staffing shortages amid a draconian staffing mandate proposal, an invasion of Medicare Advantage and mixed efforts at adapting to Minimum Data Set (MDS) changes are among a litany of the challenges facing the skilled nursing sector at the start of 2024. However, all is not doom and gloom […]

Humana Is Latest To Face Lawsuit for AI-Based Denials of Medicare Advantage Claims in Nursing Homes

In facing a class-action lawsuit for its use of artificial intelligence in denying claims for services to residents in post-acute care, Humana (NYSE: HUM) joins the ranks of other health insurance behemoths such United Healthcare and Cigna. The complaint, filed late Tuesday, in a federal court in Kentucky, accuses Humana of using AI tools – […]

Marquis CEO Fogg: Negotiating Power with Medicare Advantage, Big-Picture Staffing Strategy Key for Nursing Homes’ Future

The proposed federal staffing mandate is a potential “kill factor” for nursing home providers, while the rise of Medicare Advantage (MA) is a “major challenge” — and how well the sector responds to these threats will play a major part in shaping the future. This is the perspective of Phil Fogg Jr., CEO of Marquis […]

Medicare Advantage Bundled Payment Model Tied to Less Skilled Nursing Facility Use

A Medicare Advantage bundled payment model for hip and knee replacements offered by Humana (NYSE: HUM) was associated with reduced skilled nursing facility use. These bundled payments were also linked to reduced spending overall for lower extremity joint replacements (LEJR) – while maintaining quality of care, according to a study published in JAMA Network. Of […]

AHCA’s CEO: Nursing Homes Must Prepare for ‘Massive’ Staffing Mandate Battle, Adapt to Managed Care ‘Mega-Trend’

Nursing homes are past the “nightmare” caused by Covid-19, but now are facing “a real business problem” that could be considerably worsened by the coming federal staffing mandate. That’s according to Mark Parkinson, CEO and president of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL). He spoke Tuesday of the urgent need to […]

After Exiting Skilled Nursing JV, ProMedica To Sell Hospice Biz in $710M Deal

ProMedica is selling its Heartland hospice and home care business to Gentiva. The deal, announced Monday, comes on the heels of nonprofit health system ProMedica divesting of nearly 150 skilled nursing facilities in a deal involving Welltower (NYSE: WELL) and Integra Health. Gentiva is the largest hospice company in the U.S. based on revenue and […]

Post-Acute, Senior Care Providers Must ‘Be the Answer’ for More Integrated Continuum

Skilled nursing and post-acute companies — and other providers serving older adults — must raise their games to deliver services within a new health care paradigm, as payers and consumers alike demand a more integrated continuum. In particular, post-acute and senior care companies must “be the answer” as large insurance companies seek ways to more […]

PruittHealth CEO: Nursing Homes Must Go Beyond ‘Cost-Effective Model of Care’

Nursing home operators have lamented for years how difficult it is to address infrastructure problems in their facilities. In some locations and under some circumstances, they’ve been able to make changes over time. The COVID-19 pandemic, however, means that such changes are not optional if operators want to survive – and they cannot be incremental. […]

Some Managed Care Plans Lift Restrictions on Skilled Nursing Coverage Amid COVID-19 — But Not All

Multiple managed care plans have made changes to their procedures for admissions to the skilled nursing setting amid the ongoing coronavirus pandemic, with several major companies suspending prior authorization requirements for admissions to a skilled nursing facility. The changes, however, are not uniform — and that’s if the managed care organization (MCO) chooses to make […]

CMS Chief Medical Officer to Leave for Role With Insurance Giant Humana

The chief medical officer at the Centers for Medicare & Medicaid Services (CMS) will be leaving the agency next month to take a new position with health insurance heavyweight Humana (NYSE: HUM). Modern Healthcare first reported the news Thursday. CMS confirmed to Modern Healthcare that Dr. Kate Goodrich, who has also served as director of […]

$4.5M Skilled Nursing Expansion in Texas; SNF Construction Delay in Michigan

Texas SNF Plans $4.5M Expansion, Including Gym and Private Rooms Arbor Grace Skilled Nursing and Rehabilitation in Kilgore, Texas is planning a $4.5 million expansion that will add 15,000 square feet to its footprint, the Longview News-Journal reported. The project will include a 2,200-square-foot therapy gym and 20 private rooms, which will bring the total number of beds […]

QCP Clears Up Investor Objections, Welltower Deal Vote Remains on Track

Quality Care Properties (NYSE: QCP) last week announced steps to clear up a pair of lawsuits surrounding its impending acquisition by fellow real estate investment trust (REIT) Welltower Inc. (NYSE: WELL). The two class-action lawsuits — Sanderson v. Quality Care Properties and Kent v. Quality Care Properties — alleged that the REIT violated the Exchange […]

Kindred Shareholders Approve Sale to Humana, Private Equity Firms

Shareholders of Kindred Healthcare (NYSE: KND) on Thursday approved the sale of its home health business to insurance giant Humana Inc. (NYSE: HUM) and a pair of private equity firms. The Louisville, Ky.-based post-acute provider announced the $4.1 billion deal last December, a few months after it began its planned exit from the skilled nursing […]

Walmart’s Health Push: First Home Health, Then Skilled Nursing?

Rumors that Walmart (NYSE: WMT) may be interested in acquiring a major health insurance provider — and soon-to-be home health care operator — shook up the long-term care industry last week. And at least one observer says there’s no reason why the retail giant’s reach can’t expand to the skilled nursing industry. The Bentonville, Ark.-based […]

Even With SNF Exit, Kindred Cautious on Future of Long-Term Care

Kindred Healthcare, Inc. (NYSE: KND) elected to exit the skilled nursing space last year due to industry headwinds, but the provider is still cautioning that the wind might not necessarily be at its back going forward. In a Monday presentation to investors, the Louisville, Ky.-based company cited low reimbursements, labor cost pressures, and the potential […]

Kindred, About to Complete SNF Exit, Sold to Humana for $4.1B

Kindred Healthcare (NYSE: KND) on Tuesday announced a definitive agreement to be acquired by a group of three companies — TPG Capital; Welsh, Carson, Anderson & Stowe (WCAS); and Humana Inc. (NYSE: HUM) — for approximately $4.1 billion in cash. The deal had been rumored over the weekend after the Wall Street Journal reported Kindred, […]

Humana, Private Equity Firms Could Soon Acquire Kindred

Near the end of a year that has already seen Kindred Healthcare, Inc. (NYSE: KND) exit the skilled nursing industry, the health care giant is still making headlines. Insurance provider Humana, Inc. (NYSE: HUM) is reportedly closing in on a deal to buy Kindred in conjunction with a pair of private equity firms, according to […]

Observation Stays Save Money for Private Insurers, Patients

Observation stays at hospitals have been controversial in the long-term care world for their role in Medicare reimbursements, but a new study shows that they could save money on the private-pay side — a trend that could have consequences for both types of insurance models. Between 2009 and 2013, non-elderly patients affiliated with three major […]

Why Value-Based Care Could Improve SNF Care, Lower Costs

Value-based programs can lead to lower costs of care and better quality of care for seniors enrolled in Medicare Advantage (MA) plans, according to an internal study from Louisville, Kentucky-based health insurance provider Humana. The study found total health care costs for practices in Humana’s value-based arrangements were 15% lower than original fee-for-service Medicare. Compared with standard […]