CMS To Increase Drug Price Transparency

The Trump Administration has finalized adjustments to Medicare Advantage and Medicare Part D to ensure patients have greater transparency in the cost of prescription drugs, along with improved visibility to their options.

Under this new rule, the Explanation of Benefits document that Part D enrollees receive should now include notice of drug price increases as well as lower-cost alternatives.

For more on this, please see the CMS press release below.

SNF Star Rating Correlates To Profitability

Skilled Nursing Facilities are discovering that investing in their Staffing Star rating doesn’t necessarily lead to profitability.

Rather, SNFs would serve better by focusing their attention on their survey and quality ratings, which show the biggest impact to their CMS five-star rating.

This Star rating is indicative of the operating margin a SNF should expect to see. For example, a five-star facility’s operating margin is a round 1.3%, but a four-star facility would see a drop by nearly half to 0.7%.

For more on this, see this article from @skilled_nursing.

SNF $887 Million Boost With CMS Proposed PPS Update

Through CMS’s proposed update to the prospective payment system (PPS) for federal fiscal year 2020, SNF’s would see an increase in Medicare payments of $887 million.
2020 marks the implementation of the Patient-Driven Payment Model (PDPM), which focuses on clinical conditions as opposed to the volume of care provided.

Under this model, CMS placed a limit that no more than 25% of therapy services provided to a SNF resident during a covered Medicare Part A stay may be in a group setting. Group is currently defined as four residents performing similar activities. However, with the proposed update, the definition would change to be two to six residents.

For more on this, see the @ReedSmithHealth article below.

New Strategy Could Overhaul Fee-For-Service

The U.S. Department of Health and Human Services (HHS) revealed new voluntary programs that could overhaul the fee-for-service model, set to launch at the beginning of 2020.

The first model is targeted towards small primary-care practices, while larger practices and health systems have other choices such as “professional” and “geographic” options.

For more on this, see the @modrnhealthcr article below.

CMS Chief Verma’s “Comprehensive review” of Nursing Home Safety and Quality Standards

CMS Chief Seema Verma recently announced a “comprehensive review” of safety and quality standards for nursing homes.

In this post, Verma highlights changes that have already been made, including stricter staffing requirements as well as aligning reimbursements with performance.

Verma’s post reminds that the federal government will continue to overhaul its regulations for nursing homes across the nation.

Part of this overhaul includes an increase in transparency around nursing home assessments, no longer posting notice of agreement terminations with deficient nursing homes in local newspapers but now posting on the CMS website.

Chief Verma also touches on the president’s budget request to Congress, which would change the frequency of nursing home surveys to help deal with increases in volume, severity of complaints and rising survey costs.

She notes that CMS is also looking to reduce paperwork and diminish administrative burdens when developing new guidelines and regulations by “removing unnecessary burdens on providers that create staffing challenges and increase cost without increasing quality.”

For more on this, see Verma’s blog in its entirety here.