Isolating COVID-19 Patients Critical for Nursing Home Safety — But PDPM Hasn’t Caught Up

The infectious nature of COVID-19 makes it imperative that skilled nursing facilities take extra precautions around any new admissions that they bring in, as well as any residents that are returning from a hospital stay. According to the Centers for Disease Control and Prevention (CDC), the procedure for SNFs is straightforward: Keep any COVID-19-positive patients […]

PDPM Boosts Medicare Rate 9% Early in COVID-19 Crisis: ‘RUGS-IV Would Have Been a Fiscal Disaster’

Skilled nursing facilities received a 9% Medicare reimbursement boost during the early days of the COVID-19 crisis under the new Patient-Driven Patient Model, a new analysis has determined — providing a crucial fiscal lifeline that may not have existed under the structure that PDPM replaced. “RUG-IV would have been a fiscal disaster for SNFs dealing […]

COVID-19 Upended Star Rating Calculations for Nursing Homes — But Nothing is ‘Frozen’

The federal government took several steps to cut red tape in the health care system to help providers across the continuum battle the COVID-19 pandemic. But while those changes included alterations to reporting requirements for skilled nursing facilities, providers won’t be exempt from the consumer-facing rating system — and they need to be aware of […]

Amid Shortages, Using PPE According to CMS Guidelines Could Cost Nursing Homes $10K a Day — Or More

Updated guidelines on the use of personal protective equipment (PPE) are causing major headaches for health care providers across the continuum, as both acute and post-acute care settings grapple with supply shortages and a surge in cases of COVID-19. Those headaches include grappling with significant shortages of equipment in the face of the highly contagious […]

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 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 […]