Senior Living Liability Claims Analysis Report

Marsh (largest insurance broker in the world) recently released its 2024 General and Professional Liability Report 2024-General-Professional-Liability-Benchmark-Report-MAR-USA. The report includes data from fifty senior living and long-term care providers comprising 10,300 closed claims with paid indemnity and expense value of $1.87 billion across a ten-year horizon. The ten-year data was used by Marsh to forecast … Read more

Doc Payment Fix in the Works?

Here’s an oldie but a goodie for today. The House Ways and Means Committee is reportedly considering a markup of legislation this month that would revamp Medicare’s physician payment system. This move could increase the likelihood of incorporating a “doc fix” into a lame duck legislative package. Historic readers and followers of Reg’s Blog will … Read more

Innovation: Think Inside the Box

Not sure how many times I’ve heard the worn phrases of “think outside the box”, “brainstorm”, “explore new perspectives”, across my career.  Now, I’m not saying that these concepts don’t have merit.  I am however, saying that most often, the best innovation comes from “thinking inside the box”. Systematic inventive thinking: the power of thinking … Read more

Nursing Assistants = Supply Shortage

Nursing assistants are anticipated to experience the largest projected shortfall among all healthcare occupations analyzed, with an expected national shortage exceeding 73,000 assistants by 2028. This projection is based on a report by Mercer, which also predicts a nationwide deficit of over 100,000 healthcare workers by the same year. The demand for nursing assistants is … Read more

Check: Medicare Advantage Coverage Issues

Late last year, CMS proposed a final rule to address the issue of coverage denials or service denials via prior authorization on behalf of Medicare Advantage Plans. Between providers and patients, coverage issues have significantly increased as beneficiary participation has increased (today, about 1 in 2 Medicare beneficiaries is in a Medicare Advantage plan). https://rhislop3.com/2023/11/09/cms-offers-fix-to-medicare-advantage-denials/ … Read more

Nursing Home Closures Creating Access Issues

With increasing older adult demand for hospital care, an ongoing wave of nursing home closures is creating post-acute access issues. Since 2020, 774 nursing homes have closed, and only seven new facilities opened in 2024. The primary driver for closure is a nationwide shortage of qualified clinical staff, exacerbated by the COVID pandemic.  The pandemic … Read more

Healthcare Fraud is Rampant and so are Costs

The U.S. spends more than any other world nation on healthcare – gross dollars and per capita. The systemic growth of spending continues at rate beyond inflation, spurred-on by an aging demographic and chronic diseases like diabetes and obesity.  Cost growth in programs like Medicare is rampant but then again, so is fraud. Federal spending … Read more

Exploring Age-Friendly Healthcare Programs

The Accreditation Commission for Health Care, Inc. (ACHC) has launched two new specialty credentials for organizations providing home care and/or hospice.  These programs are in line with the Age-Friendly Health Systems (Care) programs and initiatives started by The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI), in partnership with the American Hospital Association (AHA) and … Read more

Fitch Non-Profit CCRC Ratings Update

Fitch Ratings has completed updates to its ratings criteria for not-for-profit continuing care retirement/life plan communities (CCRCs), enhancing the reflection of the risk profile for these rated entities. These changes come after a period of commentary on a draft released earlier this spring. The criteria modifications aim to more accurately represent the distinct risks associated … Read more

TEAM Model and Post-Acute Care

The mandatory Transforming Episode Accountability Model (TEAM) will advance CMS prior work on value-based care models, including bundled care initiatives. The TEAM model (participation) will be mandatory for selected hospitals and participation “optional” for post-acute care providers. Transforming Episode Accountability Model (TEAM) | CMS The Transforming Episode Accountability Model (TEAM) is set to be a … Read more