CMS Overhauls Skilled Nursing Payment Plan, Increases Rate by $850 Million
“The Centers for Medicare & Medicaid Services (CMS) on Friday unveiled a new proposed model for skilled nursing reimbursements that the agency says will save providers $2 billion over the next decade,” Skilled Nursing News reports. “The proposed Resident Classification System, Version I (RCS-I) is out, and the Patient Driven Payment Model (PDPM) is in, with an effective start date of October 1, 2019. CMS framed the move as a concession to providers based on feedback regarding RCS-I, pointing out that the PDPM has an 80% reduction in payment group combinations as compared to the initial plan and would slash reporting requirements, potentially saving providers $2 billion per year. In the same swoop, CMS also released payment rate changes for fiscal 2019 under the new rule: SNFs will see a boost of $850 million in Medicare money based on a market basket update of 2.4%.”
Welltower, ProMedica Look to ‘Reinvent’ Skilled Nursing with QCP Deal
“After seeing major players like Humana and TPG Capital take billion-dollar bets on vertical health care integration, Welltower Inc. (NYSE: WELL) is getting in on the action as well,” reports Skilled Nursing News. “The mega-deal will see Welltower take over QCP’s real estate in a joint venture with ProMedica, while the hospital provider will purchase operations of HCR ManorCare, the second-largest nursing home chain in the United States. But observers shouldn’t call it a skilled nursing deal, according to Welltower CEO Tom DeRosa — who went as far as saying that ‘SNF’ has no become something of a ‘pejorative term.’ Instead, the idea is that ProMedica can use the existing skilled nursing infrastructure to experiment with the delivery of post-acute care.”
Assisted Living is Area of Fastest Growth for AHCA/NCAL
“Assisted living continues to be the fastest-growing segment of membership for the American Health Care Association / National Center for Assisted Living, NCAL said Thursday in newly issued annual report for 2017. The total number of assisted living beds represented by members increased 13,701 over the course of the year, NCAL said, going from 217,003 to 230,704,” according to McKnight’s Senior Living. “Member companies were evenly split between multi-facility owners and independent owners as of Dec. 31. Sixty-one percent of members were in the for-profit arena. Forty-three states now have NCAL affiliates, with South Carolina being the most recent one to form in 2017, according to the one-page document.”
Under-65 Nursing Home Population Grows in Some States, Putting New Emphasis on Mental Health Care
“Though nursing facilities have traditionally been designed to treat the elderly, younger residents are using facilities more often — bringing with them fewer physical demands and more behavioral health diagnoses,” according to McKnight’s Long-Term Care News. “‘We’ve typically had this image of a nursing home of being (for) older adults, and now they are middle older adults,’” said Ian Matt Nelson, a research scholar at Miami University’s Scripps Gerontology Center. Nelson recently co-authored a report on this new generation of nursing home residents for the state of Ohio, where 20% of Medicaid long-stay residents were under 65 in 2015. That puts it 11th in the nation. Across the country, the under-65 proportion of residents climbed steadily from 16.5% of residents in 2011 to 17.4% in 2015. The rate jumped most for those between 55 and 64, up from 9.8 % to 11.1% in 2015. A close look at Ohio reveals how shifting demographics can impact needed services and skill sets. Almost half of the young Ohio residents had a diagnosis of severe mental illness — including bipolar disorder or schizophrenia — and nearly a quarter had paralysis. Those numbers compared to one-quarter and one-tenth, respectively, among seniors.”
