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Over the next 30 years, the Medicare program will account for nearly 80 percent of the increase in health care spending. This growth will continue to put pressure on the already dire situation facing the Hospital Insurance (HI) Trust Fund, which is expected to be bankrupt in 2028. Because of these looming fiscal issues, policy makers must be hypervigilant about the services paid out of the HI Trust Fund, including skilled nursing facility (SNF) and home health agency (HHA) services. Long criticized by the Medicare Payment Advisory Commission for driving profits over patients, SNFs had a marginal Medicare profit of 25 percent in 2020 and HHAs had a 23 percent profit. To address these issues the Centers for Medicare and Medicaid Services (CMS) recently embarked in comprehensive payment reform.