The latest proposed changes to the REACH accountable care organization (ACO) may make it even easier for skilled nursing facilities to be a part of an ACO program – and there may be implications for quality of care, industry leaders said. A broadened criteria and an attractive high needs population track is expected to be […]
As managed care plans continue to reshape the skilled nursing landscape, operators must navigate the complexities of managing patients under managed healthcare programs, including maintaining patient census levels, adapting to industry-specific policies, and addressing issues related to case managers’ involvement. As Medicare Advantage continues to penetrate the nursing home market, leaders have said that MA […]
Hospital systems and skilled nursing facilities are redefining their relationships in response to manifold challenges and changes affecting the continuum of care. One example: In the midst of the Covid-19 public health emergency, NorthShore University HealthSystem — which became the third-largest health care delivery system in Illinois after a 2022 merger with Edward-Elmhurst Health — […]
As nursing home organizations adjust to a changing environment of reimbursement, Medicare Advantage Institutional Special Needs Plans (I-SNPs) are undergoing rapid growth, with operators pursuing distinct strategies meant to realize financial and operational gains. The benefits of an I-SNP can range from more control over quality, happier clinical staff, reduced administrative burdens, improved compensation and […]
The rise of managed care plans among nursing home beneficiaries has meant that nursing home providers have had to make tough choices to balance the pros and cons of such plans to reap profits. And, despite a proven track record of handling higher acuity, many providers may not think to use this to their advantage […]
Following the Biden Administration’s bid this week to reduce the price of certain drugs – many of which are commonly used in nursing homes – experts are cautioning that the changes may negatively impact the bottomline of organizations in the sector. As Medicare Part D price negotiations for these drugs come into focus this week, […]
It appears the Centers for Medicare & Medicaid Services (CMS) is paying particular attention to managed care payers as the agency re-examines data submission requirements for skilled nursing services through the Minimum Data Set (MDS). Nursing home operators were able to comment on various MDS-related questions posed by CMS officials during a Quality Reporting Program […]
Some nursing homes are seeing “significantly more” audits tied to managed care and dual plan Medicaid claims in certain states – and potentially could see the same from Medicare too. This is all on top of an improper payment probe the Centers for Medicare & Medicaid Services (CMS) is conducting for Patient-Driven Payment Model (PDPM) […]
As managed care plans become more and more relevant to the nursing home industry, it appears Medicare Advantage beneficiaries are experiencing less favorable outcomes, while using less post-acute care services than those on traditional fee-for-service Medicare. A study published in JAMA Health Forum on Friday suggests that MA enrollees reported less functional improvement while using […]
The skilled nursing sector is under increasing pain due to the growth of Medicare Advantage, with the industry losing hundreds of millions of dollars while operators also are contending with a host of operational burdens. This was a message delivered repeatedly Wednesday at the “Roaring Reimbursement” conference held by Zimmet Healthcare Services Group (ZHSG) in […]
While staffing shortages continue to create admission roadblocks, the demand for skilled nursing care is recovering. From April to May, SNF occupancy decreased 3 basis points to end at 81%, according to the latest skilled nursing monthly report released by NIC MAP Vision. Pre-pandemic occupancy was 88.9%. Still, occupancy is up 97 basis points compared […]
Nursing home operators can expect a long comment period once the federal minimum staffing mandate comes out, potentially drawing out into the following year before anything is finalized. Barry Port, CEO of the Ensign Group (Nasdaq: ENSG), said during the company’s second quarter conference call on Friday, that this is the tiniest bit of clarity […]
Leaders at nursing homes could create long-term value for their organizations if they adopted a population health focus, empowered local leaders and pursued actively value-based purchasing models. That’s according to a report published by CliftonLarsonAllen (CLA) earlier this month. In an industry facing seismic changes, SNF operators should seize strategic opportunities, empower local leadership, and […]
Rising acuity at nursing homes has meant a greater need for the presence of various clinical specialties at facilities. But navigating better interdisciplinary team care is a complicated matter, made more so with staffing shortages, tighter regulation and lower reimbursements. As the needs of the nursing home population continue to evolve, many providers believe it’s […]
The Medicare Advantage preauthorization process and denials of care are a growing concern across the continuum, and nursing home operators and advocates — as well as federal lawmakers — are pushing more urgently for change. Such concerns are not new, and already some action has been taken: the Centers for Medicare & Medicaid Services (CMS) […]
A Medicare Advantage bundled payment model for hip and knee replacements offered by Humana (NYSE: HUM) was associated with reduced skilled nursing facility use. These bundled payments were also linked to reduced spending overall for lower extremity joint replacements (LEJR) – while maintaining quality of care, according to a study published in JAMA Network. Of […]
Concerns about lack of skilled nursing access for cancer patients, as well as oncology-related costs borne by skilled nursing facilities, have prompted operators to call for action from the Centers for Medicare & Medicaid Services (CMS). Several nursing home professionals raised this issue in comments to CMS’ proposed Medicare payment update for 2024. One oncology […]
United Church Homes (UCH), which provides a range of care and services to older adults in skilled nursing centers and other settings, is making a value-based care play that involves health plan provider CareSource. Ohio-based UCH and Metta Healthcare, the parent company of Ohio’s Hospice and Pure Healthcare, are forming a new nonprofit entity called […]
As rising acuity and reimbursement challenges stymy nursing home workforce growth, third party contracts have been increasingly responsible for providing daily services. Whether its providing resident-facing clinical work, including use of third party doctors, supplying medical equipment or rendering back office services that focus more on ensuring proper documentation for reimbursement, third parties are increasingly […]
In 2019, there were about 46.6 skilled nursing facility stays per 1,000 Medicare Advantage beneficiaries on a national basis. That’s according to data released Monday by the Centers for Medicare & Medicaid Services (CMS), on the utilization of skilled nursing facilities among beneficiaries enrolled in Medicare Advantage plans. The data also showed there were about […]
