Policy analysts at the nonpartisan agency that advises Congress on Medicare policy are planning to investigate potential coding distortions, payment inaccuracies and whether financial incentives influence patient selection by nursing home providers as part of an assessment of payment accuracy in fee-for-service Medicare’s skilled nursing facility and home health payment systems. At its October meeting […]
Institutional Special Needs Plans (I-SNPs) can increase on-site care and reduce hospital use for nursing home residents, policy analysts with a nonpartisan agency that advises the U.S. Congress on Medicare policy said Friday, cautiously endorsing expansion of the I-SNP footprint in the sector – currently used by only about a third of nursing homes. The […]
Medicare spends 14% more on Medicare Advantage (MA) enrollees than if they were to be enrolled in Medicare Fee-for-Service (FFS), equating to roughly $76 billion in additional spending estimated for 2026, according to the latest report from the Medicare Payment Advisory Commission (MedPAC). Medicare spent $537 billion on MA plans in 2025, not including prescription […]
The Medicare Payment Advisory Commission (MedPAC) is once again beating the drum for reducing Medicare payment rates for skilled nursing facilities. Specifically, the commission’s draft recommendation calls for a 4% cut to the Medicare base payment rate to SNFs for fiscal year 2027. In the commission’s Dec. 5 public meeting, analysts presented on the payment […]
While Centers for Medicare & Medicaid Services (CMS) has made improvements following previous recommendations from the Medicare Advisory Commission (MedPAC), the Medicare Advantage (MA) program and the value-based purchasing program still suffer from “design flaws,” according to the organization. MedPAC is calling attention to what it perceives as design flaws in the programs, including incentives […]
The Medicare Payment Advisory Commission (MedPAC) has recommended that Congress reduce nursing home Medicare base payment rates by 3% for 2026. The Commission tempered their cut, they said, acknowledging uncertainty around the impact of the new nurse staffing requirements on costs to the sector next year. While many in the sector expect the mandate to […]
More government scrutiny of Medicare Advantage (MA) plans and data sharing with nursing homes could reduce claims denials and burdens associated with such plans, sector leaders have long argued. And now a report released Thursday by a Congressional advisory body backs that view in shedding light on how enrollees are captured in data. The Medicare […]
The majority of MedPAC board members voted Thursday to recommend reducing Medicare-based payment rates for skilled nursing spending by 3% for 2025, despite voicing concerns about the federal minimum staffing proposed rule. MedPAC, which stands for the Medicare Payment Advisory Commission, is made up of health care professionals who make recommendations to Congress in terms […]
The Medicare Payment Advisory Commission (MedPAC) is recommending that for fiscal year 2025, Congress should reduce the 2024 Medicare-based payment rates for skilled nursing facilities (SNFs) by 3%, citing strong margin projections, occupancy growth and access to capital for the sector. “We project the SNF margins in 2024 to remain high even with the downward […]
As Medicare Advantage continues to penetrate the nursing home market, leaders say that MA plans are depressing margins amid higher costs to run operations. This might lead some operators to contemplate closing, while others will be wiser to hire staff in designated roles to help them negotiate better rates – and exclusions – for managed […]
The Medicare Payment Advisory Commission (MedPAC) unanimously voted Thursday to approve its recommendation for a 3% Medicare payment cut for skilled nursing providers in 2024. This move follows the Commission’s draft recommendation discussed during a meeting on Dec. 9. Despite the proposal for a rate cut, MedPAC commissioners have noted that the industry is facing […]
With referrals to nursing homes under pressure, thanks to a bottleneck in part caused by the ongoing staffing crisis, hospitals are urging more support for post-acute providers. The American Hospital Association (AHA), for one, has called for “law updates” when it comes to hospital-based skilled nursing facilities and inpatient rehabilitation facilities (IRFs). AHA on Tuesday […]
As federal minimum staffing requirements loom for skilled nursing providers, analysts with the Medicare Payment Advisory Commission (MedPAC) unveiled crucial data detailing the effects of state-level standards on the industry. While research found state minimum staffing requirements increased staffing levels and in some cases improved quality measures, there were some unintended consequences: a decrease in […]
Home health agencies surpassed skilled nursing facilities as the most sought after post-acute care setting – SNF care went from most common to second-most used among Medicare beneficiaries, crossing paths with home health in February 2020 as the pandemic ramped up. By March 2020, the number of hospital discharges referred to SNFs dropped to 16.6% […]
The skilled nursing sector needs an overhaul in how facilities are paid – and how operators are allowed to allocate government dollars – in order to really live up to the term “nursing home.” That’s according to Harvard University professor David Grabowski, who — in referring to observations made by the late Robert Kane — […]
Skilled nursing operators are presently eyeing a $320 million proposed decrease to Medicare funding at a time when a historic labor crisis and federal policies and rhetoric have a chance to make a mark on the industry for years to come. In just the last few months, the Biden administration unveiled its nursing home reform […]
After delaying cuts last year due to Covid, the Centers for Medicare & Medicaid Services (CMS) announced last week that it is moving forward with proposed cuts to Medicare funding for nursing homes. The CMS proposal includes a 3.9% Medicare rate increase for skilled nursing facilities, but the agency announced cutbacks to PDPM payments by […]
Capital providers dealing in the skilled nursing space are pushing back on the White House’s position on institutional capital, stressing the need for it in the sector. While institutional capital is critical to many of the key players in the space, some capital providers say newer owner-operators will have a hard time getting the necessary […]
While industry leaders have bashed many of the proposals laid out in the Biden administration’s nursing home reform package, improving public transparency of SNF ownership may be the White House’s best plan to curb who they see as “bad actors.” However, the details will be important to get right, with concerns about the impact that […]
While the Biden administration is seemingly trying to push private equity out of the skilled nursing sector, there seems to be growing confusion and frustration on how blaming such a small fraction of the overall sector is going to solve some of the challenges the industry currently faces. The skilled nursing market has been one […]
