‘CMS Loves That’: Moderate Therapy Shifts, Bureaucratic Reality Could Slow PDPM Changes

Despite steady reports of increasing reimbursements under the new Medicare payment model for nursing homes, at least one industry leader believes that the federal government will be happy with the early returns — and that any changes are fairly far down the road. Skilled nursing operators have not gone overboard with the strategy changes that […]

‘Pendulum Swung Too Far’: Therapists Raise Concerns Over Layoffs, Clinical Changes Under PDPM

It’s four months into the Patient-Driven Payment Model (PDPM), and despite some industry analysts pointing to early gains for nursing homes, many occupational, speech, and physical therapy advocates continue to criticize layoffs and changes to resident care patterns. On the operational side, the initial PDPM returns have been positive: For instance, 67% of nursing homes […]

Winners Still Outnumber Losers in Latest PDPM Analysis, But Length of Stay Trends Could Erase Rate Gains

The latest analysis of the new Medicare payment model for nursing homes again shows more operators scoring gains than suffering losses, but the change from the previous system may not be quite as straightforward — particularly as fee-for-service Medicare continues to lose ground to other payment sources. A little more than 67% of skilled nursing […]

New Group Aims to Help Skilled Nursing Facilities Avoid Expensive Purchasing Missteps

A new non-profit society aims to improve education for purchasing directors at post-acute facilities, so they can make better decisions for both the bottom line — and for their long-term future. The approach the organization — the Society for Healthcare Organization Procurement Professionals (SHOPP) — is taking is two-pronged, according to Ari Stawis, director of […]

Early PDPM Claims Data Reveals Far More Winners Than Losers, ‘Impossible Combinations’ of Conditions

The first round of claims data under the new Medicare payment model for nursing homes shows that the majority of operators are seeing reimbursement boosts — while some are also making key billing mistakes that could result in missed payments for certain services. The average skilled nursing facility saw Medicare reimbursements of $614.96 per patient […]

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 […]