Healthcare, Senior Living, Economics
Yesterday, a story in the Washington Post highlighted a series of wandering cases where residents from an Assisted Living or Memory Care facility wandered and were later, found dead. Industry insiders knew this story was coming and yesterday, it dropped. In many ways, it is eerily similar to a PBS story a decade ago around poor care/neglect … Read more
It was only a matter of time before litigation came forward regarding the use of Artificial Intelligence (AI) in primarily, Medicare Advantage plans, where coverage denials/determinations are at issue. This week, a class action suit dropped in the U.S. Circuit Court of Western Kentucky against Humana. A link to the suit is here: https://www.scribd.com/document/692182281/Humana-AI-NaviHealth-MA-lawsuit In … Read more
Happy Hump Day! Only 12 more shopping days until Christmas! In mid-November, CMS issued a final rule titled: “Medicare and Medicaid Programs; Disclosures of Ownership and Additional Disclosable Parties Information for Skilled Nursing Facilities and Nursing Facilities; Medicare Providers’ and Suppliers’ Disclosure of Private Equity Companies and Real Estate Investment Trusts“. The final rule is … Read more
Yesterday I wrote about MedPAC’s rate recommendations for SNFs for FY 2025. Recall, MedPAC makes these recommendations annually, assuming the full commission votes (in January 2024) for the recommendations as released by draft. The final recommendations go to Congress. Yesterday’s post was the “draft” position for SNFs. Today, I’m including summaries for Home Health, Hospice, … Read more
The Medicare Payment Advisory Commission is (likely) recommending to Congress a series of post-acute rate reductions (Medicare, Fee-for-Service) for federal fiscal year 2025 (beginning October 1, 2024, for most programs, January 1, 2025, for Home Health Agencies). Specifically, the MedPAC recommendations are as follows. Reduce the 2025 payment rate for home health agencies by 7%. … Read more
I get asked about value-based care a lot. It is a buzzword or term these days, somewhat driven by the rise in Medicare Advantage enrollment. Frankly, it is a bit of a catch-all concept that has its origins in Medicare and various demonstration projects (e.g., bundled payments) and the implementation of quality measures to “improve … Read more
Since the COVID pandemic, regulatory officials have escalated the review, via various audits, of SNF emergency preparedness. COVID highlighted the sporadic and often, non-existent preparations for disasters (natural and other) and disease outbreaks (pandemic or other) that existed with the SNF industry. In reality, the issues have been present for years but only regionally, highlighted … Read more
A complex area for providers, especially with respect to their compliance programs, are the concepts of fraud and abuse. Central to current requirements for compliance programs, all post-acute providers are REQUIRED to have compliance programs that, Include policies and procedures to define, test for, and mitigate any issues pertaining to fraud and abuse. In this … Read more
Even after all of the years that I have been in health care and particularly, post-acute care, I still field a good number of questions regarding Hospice, the benefit under Medicare, how payments work, and what the generalized payment amounts are. Having started a few hospices in my career, I can attest that done right, … Read more
On November 1, CMS issued the final PPS rule for Home Health (2024). The majority of provisions within this rule, especially those related to payment, take effect on January 1, 2024. The Final Rule as published is available for download here: Home Health 2024 Final Rule In July I wrote a post on the proposed … Read more