Each Medicare Advantage Plan Can Treat PDPM Differently — and SNFs’ Mileage Will Vary

Skilled nursing providers looking for a simple answer to how managed care plans will react to the new Medicare payment model will likely have to face an inconvenient truth: It’s complicated. Private Medicare Advantage insurers didn’t have to follow the old Resource Utilization Group (RUG) model when deciding how to reimburse for skilled nursing services, […]

Unpacking the New Therapy Contract Math for Skilled Nursing Providers Under PDPM

Faced with a sea change in the Medicare reimbursement system for nursing homes, operators have spent the last year asking a key question about their therapy offerings: outsource or in-house? And if the answer is outsource, what will that relationship look like moving forward in unfamiliar payment landscape? There’s no one correct answer for contract […]

Investing in Skilled Nursing Tech Isn’t Worth Much Without Employee, Leadership Acceptance

Data continues to be the watchword in a skilled nursing marketplace where hospitals and other referral partners demand increasingly concrete information about post-acute outcomes. In response, numerous tech companies have stepped into the fray to provide potential solutions — from data analytics tools that can identify serious health issues before they escalate to a hospitalization, […]

I-SNP Exec: Skilled Nursing Operators Must Approach Insurers to Succeed — But Few Do

Skilled nursing operators frequently bemoan the shorter lengths of stay and lower daily payment rates for Medicare Advantage residents, but the leader of one plan says it’s also up to providers to present novel ideas to insurance executives. Before taking the CEO role at the nursing-home focused Longevity Health Plan earlier this year, René Lerer […]

Treating Depression Could Emerge as a PDPM ‘Linchpin’ — Both for Payments and Better Outcomes

Accurately diagnosing and treating depression could bring significant rewards for operators under the new Medicare payment model for nursing homes — both financially and clinically. Training frontline caregivers to notice the signs of depression among residents of skilled nursing facilities will be vital to success under the coming Patient-Driven Payment Model (PDPM), according to Zimmet […]

PDPM Could Create Risk-Sharing Opportunities, Headaches for Skilled Nursing

Risk-sharing has loomed large in health care reform efforts over the last decade, and the new Medicare payment model for skilled nursing facilities could open up additional avenues for operators to take control — along with pointed questions from partners along the spectrum. The Patient-Driven Payment Model (PDPM) marks a step toward a long-teased site-neutral […]

Skilled Nursing Dealmakers Could Be Overlooking PDPM’s Potential for ‘Biggest Year’ in Decades

The market will still need to determine whether the new Medicare reimbursement structure for nursing homes will be a net positive or negative for the industry, but at least one insider says buyers and sellers in the space aren’t optimistic enough. Current prices for skilled nursing facilities don’t typically account for the potential of cost […]

PDPM Goes Beyond Therapy: Finding the Hidden Value in Skilled Nursing Ancillaries

At surface level, the new Medicare payment model for nursing homes revolves largely around therapy, as the federal government works to realign incentives and prevent what officials claim to be a wave of unnecessary services. Speech, occupational, and physical therapy account for three of the five components of the Patient-Driven Payment Model (PDPM), and providers […]

Providers Can’t Lose Sight of ‘Where the Money Is’ Under PDPM

When it comes to the changes coming to Medicare reimbursement methodology, coding figures prominently in the discussion among skilled nursing providers. But while it’s important for SNFs to make sure staff education and training on that topic is up to date, there are several other components of reimbursement under the Patient-Driven Payment Model (PDPM) that […]

PDPM 101: What Skilled Nursing Providers Need to Know Now

With a new Medicare payment model for skilled nursing facilities just months away, operators who haven’t started planning for the changes are already months behind. Skilled Nursing News has been reporting on the new Patient-Driven Payment Model (PDPM) since the day it was finalized last July 31, and we’ve spent those eight months speaking to […]

Nurses May Need to Shoulder Documentation Burdens Under PDPM

Once the new Medicare payment model takes effect, frontline nurses may prove vital to securing the proper reimbursements for skilled nursing services. The Patient-Driven Payment Model (PDPM) will place increasing pressure on nursing facilities to justify each resident’s need for Medicare-reimbursed skilled care, Zimmet Healthcare Services Group president Marc Zimmet said during a recent industry […]

Lessons from Medicare Cuts to Skilled Nursing Go Beyond Winners, Losers

At face value, the statistics look grim: Nearly three-quarters of the nation’s skilled nursing facilities will see pay cuts in 2019 under the government’s value-based purchasing (VBP) program after failing to reach mandated readmission benchmarks. But the numbers themselves don’t tell the full story, according to players in the long-term health care space. Based on […]

Skilled Providers Can No Longer Be Independent Players, Executives Believe

A majority of skilled nursing and seniors housing executives believe skilled nursing providers can no longer be independent players in the post-acute care continuum — and almost 20% see integration as a necessity. According to a survey conducted by real estate lending, investment, and advisory company Greystone and administered by Marc Zimmet of Zimmet Healthcare Services […]

In-House Health Plans Provide Path Out of Managed Care Pain for Operators

As the long-term health care industry moves into a value-based payment world, a special type of Medicare Advantage plan could offer skilled nursing providers a path to get ahead. In fact, institutional special needs plans (I-SNPs) could be the future for skilled nursing facilities battered by the changes in reimbursement, the move to value-based models […]

New Analytics Platform Targets SNFs’ Growing Data Needs

Zimmet Healthcare Services Group on Thursday launched an analytics platform specifically targeting financial and reimbursement professionals in the skilled nursing space. Providers’ data needs are only likely to grow with the implementation of the Patient-Driven Payment Model (PDPM) on October 1, 2019. “There’s going to be tremendous variation in nursing home Medicare expenditures [with PDPM], […]

Skilled Nursing Providers Have One Shot at Payment Success Under PDPM

Of all the changes coming to the skilled nursing industry when a new payment model takes effect next fall, the most pressing may be one of the most basic: Starting in October 2019, providers will have a single opportunity to set themselves up for financial success with a patient’s initial assessment. The Patient-Driven Payment Model, […]