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 around 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 the 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, the 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.

Skilled Nursing Facilities Sudden Star Ratings Decrease

Approximately 36% of SNFs experienced a drop in stars this week according to the American Health Care Association

With many providers losing one or more stars in quality, many SNFs trace this star decrease back to nurse staffing which has the greatest impact on quality.

Quality has been a major focus as Centers for Medicare and Medicaid (CMS) found a direct correlation between staffing levels and the quality of care a nursing home delivers. When staffing increases, quality in turn increases.

This article from McKnight’s elaborates on this.

Why Nursing Home Revenue Is Declining

While expenses continue to rise, revenue is declining for nursing homes according to a report provided by @MarcumLLP.

This article from @skilled_nursing outlines how nursing homes arrived at an average loss of four cents per patient day in 2017. A combination of lower occupancy rates along with many residents now being enrolled in managed care programs, typically paying less than standard programs, are impacting revenue.

With PDPM On The Horizon, SNFs Must Continue To Focus

With the new PDPM model less than six months away, SNFs will need to continue to focus on their day-to-day deliverables to ensure their STAR rating, hospital readmissions and other details are not impacted.

This article from @skilled_nursing notes how the transition from the RUG-based world to PDPM, a monumental payment overhaul, could easily steal the attention of Providers.

“The Greatest Opportunity” For SNF’s

When contemplating what solutions might help SNF’s thrive in the future, one suggestion would be to evolve into a short-stay facility that would essentially cut the emergency room “out of the equation entirely”.

This article from @skilled_nursing notes “the greatest opportunity” would be for SNF’s to partner with Medicare Advantage plans and prove their ability to provide high-quality care.

Medicare Advantage- Coordinated, Value-Based Care

Thanks to the care navigation that Medicare Advantage provides, consumers are experiencing value and simplicity. For several reasons, MA enrollment has increased over 30% in the past four years.

A privately-run system rather than government-run, MA is proving to be valuable to consumers in both quality of care as well as financially. Through care navigation, MA makes it easier to navigate the healthcare system as well as choose a provider.

This article from describes how Medicare Advantage has rebranded itself through time, detailing out major players in the game and its trajectory for the future.

Skilled Nursing Facilities Payment Will Be Impacted By PDPM

When the Patient-Driven Payment Model (PDPM) takes effect in October 2019, Payers using the RUG system will have until September 30, 2020 to adjust their rate calculations.

With the variety of changes nearing, SNF staff will be forced to pay closer attention than ever before to their coding and billing.

This article from @skilled_nursing sheds light on this, detailing out suggestions for SNF’s to consider when approaching the changes to come.