Sunday, September 20, 2026 - Updated Daily
Sunday, September 20, 2026 - Updated Daily
Medicare Advantage plans are paid through risk adjustment. The government sends each plan a fixed monthly amount per enrollee, and that amount rises when the enrollee’s record contains certain diagnosis codes. The system assumes sicker…
Healthcare reform is not a single bill. It is three separate changes moving through the federal system at once, and only one of them touches a skilled nursing facility’s day-to-day operations directly. Operators who treat…
Medicare Advantage vs traditional Medicare is no longer a beneficiary-choice discussion alone. It is a market-structure issue affecting referral patterns, hospital utilization, post-acute length of stay, network access, risk-bearing arrangements, and the financial viability of…
Medicare post-acute care (PAC) reimbursement is increasingly driven by stricter federal spending controls, closer Medicare Advantage (MA) utilization oversight, and limited rate increases. Current policy priorities center on value-based accountability, shifts to lower-intensity care settings,…
The practical question is not whether value-based care affects operators. It already does. The more consequential question is whether an organization recognizes the change early enough to redesign how it manages referrals, clinical performance, workforce…
The report that CMS is withholding $1B in Medicaid payments from California and Minnesota is not merely another Washington-versus-state-capital political skirmish. It is a reminder that Medicaid is financed through a conditional partnership, and federal…
Rural providers are being asked to preserve access with urban-level expectations and far thinner margins. That is the core tension any rural health transformation program must confront. For hospitals, post-acute operators, clinics, and community-based organizations…
For years, and littered throughout this site, are pieces (and presentations) I have done on compliance. Some goodies are below. https://rhislop3.com/2023/09/07/five-quality-and-compliance-tips/ https://rhislop3.com/2018/11/16/the-real-impacts-of-poor-quality-inadequate-compliance-and-weak-risk-management/ https://rhislop3.com/2018/11/29/follow-up-real-impacts-of-poor-quality-and-lax-compliance/ https://rhislop3.com/2019/06/14/the-connection-between-quality-and-revenue/ The one major implication of solid (or not) compliance is the…
Healthcare executive, consultant, and author covering post-acute care, senior living, and the economics behind both - for 30+ years.
No noise - just what changed in healthcare policy and economics, and why it matters to your operation.