The PDPM-realized average for skilled nursing facilities was about $615 per day, while it was simulated to be $563 per day under RUG-IV,  according to a November analysis by consulting firm Zimmet Healthcare Services Group.

The review found that 91.5% of SNFs were “winners,” meaning they enjoyed a positive PDPM impact, while just 8.5% experienced reduced payments. 

Zimmet experts said federal regulators are expected to recalibrate rates. They also warned of tougher audits for SNFs, and urged providers to ensure that “everything being captured is being documented” in order to maximize reimbursements. 

Notable by its absence was Section G, which has been eliminated “from all Federal item sets.”

Section G is used to calculate quality measures, including those related to function (short-stay function) and Percent of Residents Whose Ability to Move Independently Worsened (long-stay).

Section GG, which was enacted Oct. 1 with the onset of the Patient Driven Payment Model, is used only for Medicare Part A.

Providers were studying the proposal at press time and expecting many more changes before a final set becomes effective Oct. 1.

The pertinent new CMS files can be found in the Downloads section of the MDS 3.0 Technical Information webpage. 

The American Health Care Association was evaluating the draft and its potential effects, including “changes that may impact many state Medicaid systems that utilize MDS assessments to determine RUG-based case-mix payment rates.”

Managed care and accountable care organizations have led to a reduction in average length of stay and payments, he said at a December AHCA conference.

One solution for long-term care during this volatile period has been to join or create institutional special needs plans, or I-SNPs, he said. These insurance models allow nursing homes to provide a higher level of care and control the disbursement of funds.

Research in postmenopausal women uncovered that those who slept for no longer than five hours per night were most likely to have lower bone mineral density and osteoporosis. 

Researchers from the University at Buffalo-New York, led the study of more than 11,000 postmenopausal women, all of whom were participants in the Women’s Health Initiative.

In an earlier study, the team found a relationship between short sleep and a higher risk of bone fracture in women.

MedPAC commissioners made the disclosure after reviewing Medicare’s payment adequacy for SNFs and discussed update options for providers in 2021 during a December meeting. 

The report, which focused on 2018 data, found that payment adequacy indicators for beneficiary access to care, quality of care, SNFs’ access to capital and Medicare payments and SNF costs were all “positive.”

The panel also recommended against payment reductions to providers due to significant changes within the industry, including the implementation of the new Patient Driven Payment Model. 

The commission will send Congress a formal report in March.

The federal government’s new alert icon warns consumers about nursing homes that have been cited for abuse or neglect citations. This breaches an important patient safety principle, long-term care medical directors said.

The open palm in a red circle, which is put next to offenders at the consumer-facing Nursing Home Compare website, transgresses a standard that calls on providers to establish blame-free environments for reporting incidents, the physician group wrote.

“We … urge CMS to rescind its decision to use the red hand icon, a damaging and punitive strategy that violates patient safety principles and is likely to reduce reporting rather than prevent abuse and neglect,” President Arif Nazir, M.D., and Executive Director Christopher Laxton said.

It also doesn’t promote accountability, they said.

The study refuted previous assumptions about the suggested link between increased risk of dementia and poor diet or lack of exercise. It involved one out of every four women born in the United Kingdom between 1935 and 1950. Their average age was 56 and they did not have dementia at the beginning of the study. 

Findings were published in the Dec. 18, 2019, online issue of Neurology.

Q: What do you see as the major long-term care payment and policy topics these days?

A: There is a major push right now to move insurance risk onto providers — whether it be full capitation or some kind of risk sharing arrangement. This is a major focus of the Centers for Medicare & Medicaid Services. In my conversations with the post-acute providers, I see them trying to understand what risk sharing means for them. 

Q: How is Medicare Advantage affecting long-term care?

A: MA enrollment continues to grow and shows no sign of slowing down. An increasing number of long-term care residents are now in MA plans rather than traditional Medicare. With MA comes managed care and the resulting push to lower the number and duration of post-acute care stays, which has revenue implications for the provider. 

Q: One of your specialties is the institutional special needs plan (I-SNP) bidding process. What should providers keep in mind?

A: The biggest challenge is the change in mind-set. Financial incentives for the long-term care facility owner are not the same as those of an I-SNP owner. Being able to reconcile those two incentives when you are both the I-SNP and the provider can be difficult, but it is very necessary in order to be successful. 

Catherine Murphy-Barron is a principal and actuary for Milliman.

A November memo issued by officials with the Centers for Medicare & Medicaid Services revealed that interpretive guidance and training on Phase 3 requirements will be released during the “second quarter of 2020,” despite the regulations going into effect on Thanksgiving Day 2019.

The announcement came as a disappointment to providers. 

“We all agree that quality nursing home care is important. Such murkiness from the top regulatory authority on Phase 3, the most complex and labor intensive of all three phases in terms of implementation, is disheartening,” Ruth Katz, LeadingAge’s senior vice president of policy and advocacy, told McKnight’s. 

“It is challenging for our members to properly implement requirements without the release of the interpretive guidance,” added Sara Rudow, the American Health Care Association’s senior director for regulatory services and survey.

“The phase three requirements are substantive and complex. We look forward to CMS releasing the guidance as soon as possible.”

“Post-acute care is on the cusp of some of the greatest changes it has seen in decades, and those operating across this growing sector of healthcare have exciting opportunities — and some interesting challenges to consider,” Dan Mendelson, CEO of Avalere Health, wrote as a Forbes contributor in December. 

The urgency for change stems from the expansion of value-based reimbursement, an increase in post-acute care utilization thanks to incentives for acute care providers, the growth of Medicare Advantage and managed Medicaid, and the popularity and high performance of provider-sponsored health plans. 

“Post-acute care providers have never played a more essential role, but to thrive in this shifting landscape, post-acute business models must change,” he said. 

Mendelson recently noted at an American Health Care Association event that Medicare spent $58.9 billion on post-acute care in 2017, which represented about 7% of total spending.

Mendelson called on providers to evaluate their risks, higher acuity abilities, experience with value-based care, and health plan offerings.