CMS Moves to Expand Telehealth Coverage Under Medicare Advantage

The Centers for Medicare & Medicaid Services on Friday unveiled a proposal that the agency says will expand telehealth coverage to enrollees in Medicare Advantage plans. Under the proposed rule, which would take effect in calendar year 2020, Medicare Advantage plans could cover telehealth services for both rural and urban enrollees, as well as in-home […]

New Skilled Nursing Payment Model Raises Medicare Advantage Questions

Providers that have learned to navigate the Medicare Advantage ecosystem will likely have a leg up when approaching the new payment model for skilled nursing facilities, but many questions still remain about how managed care plans will adapt under the coming system. The Patient-Driven Payment Model (PDPM) reflects an ongoing push toward rewarding therapy providers […]

What Skilled Nursing Providers Can Learn from Baseball’s Data Revolution

At a recent industry conference, I watched a pair of presenters show some fairly eye-opening statistics about workforce retention. The studies they cited weren’t health care-specific, but they did demonstrate that conventional wisdom about hiring — specifically, that years of experience and education correlate with strong job performance and retention — is wrong. In fact, they […]

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 […]

Quality, Scope of Medicare Advantage Plans Varies Widely

As Medicare Advantage becomes increasingly common in the skilled nursing space, consumers may still have trouble determining whether a plan works best for them — or even provides quality coverage with access to a wide variety of physicians and SNF care. And even if a potential MA enrollee finds a plan that appears to cover […]

Avoiding Multi-Million Medicare Advantage Mistakes at SNFs

New payment models frequently shoulder the blame for the uncertainty surrounding the skilled nursing marketplace, as operators struggle to shift from the private-pay and Medicare of the past to Medicare Advantage and other new reimbursement methods. But, according to one SNF consultant, the time for blaming new models is over — and the only thing […]