News

Last week, the American Health Care Association and National Center for Assisted Living hosted the first Population Health Management Summit which focused primarily on how the healthcare landscape is shifting from volume to value.

Medicare Advantage plans, positioned to drive payment and delivery reform, are expected to become the dominant form of Medicare by the year 2025.

For more on this, please see the below Forbes article.

Three health networks in Boston formed an accountable care organization (ACO) this year, the Beth Israel Lahey Performance Network (BILPN). This ACO sees an opportunity in sending patients directly to a skilled nursing facility (SNF) without requiring a three-day hospital stay.

BILPN’s three-day waiver program is meant to provide a path for patients who don’t necessarily meet the criteria to be admitted to the hospital but would benefit from care in a place better suited to address their needs.

For more on this please see the article below.

Hospitals will have until 2021 to comply with the rule to publish payer-negotiated prices. This rule, requiring hospitals to post rates in a more convenient format, was originally slated to begin in 2020.

For more on this, see the article below.

According to the 2019 Industry Trend Report from Trella Health, skilled nursing facility (SNF) admissions are dropping across the country while home health agencies have become the most likely post-acute referral destination.

Some states have seen a decline in SNF admissions anywhere between 14% and 26%.

For more on this, see the article below.

Managed Care continues to grow!

This decade, there has been a 10% increase in Medicare Advantage enrollment for all eligible beneficiaries.

For more on this and how the majority of seniors are more than satisfied with Managed Care, see the article below.

Hospitals are demanding national standards for prior authorizations regardless of which Payer they are working with.

Hospitals often believe they have followed the required steps and process flawlessly, only to discover their claim was denied. This inevitably leads to a painful and lengthy appeals process.

This article addresses the pain points many providers are feeling as well as suggestions to provide clarity to the prior authorization process.

CMS has finalized a new rule requiring hospitals to give patients better visibility to their post-acute provider choices.
This rule will not impact the anti-steering regulations that prevent hospitals from recommending specific skilled nursing facilities, but rather enlighten the patient to make a more informed decision to their post-acute care while also considering their goals of care and treatment preferences.

For more on this, see the article below.

With mergers-and-acquisitions becoming more prevalent in the skilled nursing space, many operators are experiencing issues with negative press, difficulties obtaining bank loans, and even Star rating impacts bubbling up from the previous owners.

For more on this, please see the article below.

With Medicaid reimbursement cuts coming to Michigan, it’s more important than ever to grow your arsenal of Managed Care contracts. Let us know if we can help!

Cyberattack prevention is more important than ever. The overwhelming majority of ransomware attacks are targeted towards small businesses that can’t afford to spend on defense. Companies have been found to pay up to four times as much to resolve an attack than they would have to prevent one.

As PHI is incredibly valuable, it will be more important than ever for SNFs to think defensively. This article details the major impact of cybercrime on businesses, Michigan in particular, being ranked number one in cybercrime complaints, and the nation’s top ten for victim losses in internet crimes.

See below for more on this.