CMS Offers Fix to Medicare Advantage Denials

An issue that has been tied to AI (artificial intelligence) and specifically, to Medicare Advantage plans, involves coverage denials. I wrote about this in a post earlier this year at https://rhislop3.com/2023/05/01/medicare-advantage-part-d-final-rule/ Coverage denials have been a fairly hot topic around Medicare Advantage plans. The core of the issue is that Medicare Advantage plans are required … Read more

Rising Health Care Costs – A Serious Issue, Election Implications?

Long time readers/followers know that I from time to time, address health care costs. I follow economics generally and write about the same, especially when there are intersectional issues to address. As we are heading into a presidential election cycle (we are in the early innings) and, issues like health care costs in this country … Read more

SNF Staffing, Mandates, and More

Seema Verma, former CMS head, spoke out yesterday regarding the proposed staffing mandate (hours and type of staff, per resident per day) proposed rule, indicating her opinion that the approach was flawed. A recap article on her comments is here: https://www.mcknights.com/news/former-cms-chief-verma-regulators-over-their-skis-with-staffing-mandate/?utm_source=newsletter&utm_medium=email&utm_campaign=NWLTR_MLT_DAILYUPDATE_110223&hmEmail=IjP1GPaY%2BJ2uvsLxTJ79bVeRWY7ycbnr&sha256email=aa4cb7c695037c31a216b9562788596b6fcd012145d566f31440b6fcd139c8a9 Regular readers know that I have covered various topics on healthcare staffing, particularly as … Read more

MedPAC and Medicare Advantage

In yesterday’s post, Mish-Mash Monday, in the section about the House Budget Committee’s Health Care Task Force, I offered some commentary regarding MedPAC (Medicare Payment Advisory Commission) and Medicare Advantage plans. I also included a letter from the senior living trade association LeadingAge to the Congressional task force that references MedPAC’s concerns regarding Medicare Advantage … Read more

Medicare Advantage – Status Update

Medicare Advantage plans or Medicare Part C and D plans continue to grow in popularity. I’ve written a number of posts on various Medicare Advantage topics, of late, coverage issues and denials, particularly for post-acute care stays. A recent post on that topic is here: https://wp.me/ptUlY-wI Medicare Advantage plans (Part C plans) include Parts A, … Read more

Value-Based Care: Why it Matters, or Should, for Post-Acute Providers

Value-Based Care is kind of a vogue term, one that I encounter quite often. I also have used it when speaking or writing and know most people have no idea what it means or how it can be developed and/or applied. Value-based care is not a new concept. Medicare tried a foray into it back … Read more

SNF Industry Update

Every year, the accounting firm of Clifton Larson Allen (CLA) produces an industry trends report based on accumulated cost report data. The report provides a good snapshot of the nursing home industry, nationwide, with insights on regions and states.  The report is available here: 38th-snf-cost-comparison-and-industry-trends-report As I’ve written on numerous posts on this site, the … Read more

Twofer Tuesday: Jimmo and Staffing Mandates

Happy Hump Day eve! There is so much going on right now with the economy, government shutdown (whew, avoided that one for a bit) dynamics, election news, and health policy that it is becoming difficult to parse topics into stuff of value. Hopefully, a couple of quick updates will make room for more insightful analysis … Read more

Five Quality and Compliance Tips

A major concentration within my firm, H2 Healthcare, is compliance work. My wife heads this section of the practice, and she is widely known as one of (if not THE) the foremost post-acute/senior living experts on clinical quality, compliance, and risk mitigation/risk management. Her book on reducing survey risk for SNFs is still available on … Read more

SNF Performance Update – Occupancy, etc.

No other segment of senior living/senior care got rocked as much by the pandemic as skilled nursing. Frankly, the industry had challenges from labor shortages and lagging reimbursement entering the pandemic (2020). The pandemic didn’t just accentuate these issues, it blew them up in terms of magnitude (impact) while adding supply chain issues, inflation, and … Read more