When I was growing up, my aunts in Montevideo had a code for emergencies: Call Yosi. My seide Simón — my grandfather — would resist seeing a doctor, resist the hospital most of all, especially when my father was traveling, and someone had to talk him into going. Even then, I understood him. Nothing about…
Mounting financial pressures among both Medicaid and Medicare payers, fragmented health care settings, and the growing use of value-based care as a cost-cutting measure are creating unique challenges and opportunities for nursing homes serving dual-eligible beneficiaries. Maintaining and evolving such plans will depend on how adept nursing homes are at providing strong data to demonstrate…
The “alphabet soup” of new value-based care models from the Centers for Medicare & Medicaid Services (CMS) can be confusing and overwhelming for nursing home operators, but there are two models that should be on every provider’s menu: the Long-Term Enhanced ACO Design (LEAD) model and Transforming Episode Accountability Model (TEAM). Brian Fuller, managing director…
The accountable care organization (ACO) model is shaping up to be the base that future value-based care models will be built on, with more than 50% of Medicare fee-for-service (FFS) beneficiaries being aligned with an ACO now. While there’s a lot of room for improvement in the ACO model, the Centers for Medicare and Medicaid…
As the Centers for Medicare and Medicaid Services (CMS) strives to improve and expand accountable care organization (ACO) models for the future, there’s a prime opportunity to better serve long-term care populations, including residents in nursing homes. For starters, the federal agency should consider simplifying the bureaucratic hurdles that keep more skilled nursing facilities (SNFs)…
The Medicare Advantage (MA) Star Ratings program is undergoing a fundamental shift. Instead of primarily rewarding health plans’ operational compliance and administrative performance, the focus is moving toward measurable clinical outcomes and member experience. As a result, medication management will increasingly influence both Star Ratings performance and financial outcomes, making it a critical area for…
As the Centers for Medicare and Medicaid Services (CMS) hits reset on an important value-based care initiative popular with health care providers, including nursing homes, providers will need to make considerations this spring on whether to participate in the new model called LEAD – short for Long-term Enhanced ACO Design. Starting in 2027, the federal…
More than a decade after accountable care organizations launched, healthcare systems are still eager to bring more skilled nursing operators into the fold, according to several acute-care speakers at the National Association of ACOs Fall Conference being held in Washington, DC, this week. Financial incentives for nursing homes to sign on to ACOs not led…
Rewards tied to improved hospital readmission rates were so small and so variable from year to year that they likely contributed to a “lack of effectiveness” for a key nursing home financial incentive program. The Skilled Nursing Facility Value-Based Purchasing program is the Centers for Medicare & Medicaid Services’ largest use of financial incentives to…
As value-based care (VBC) continues to redefine reimbursement models and quality standards in skilled nursing facilities (SNFs), the Director of Nursing (DON) plays a central role — driving clinical excellence, operational efficiency and financial performance. With hospitals, health plans and VBC programs increasingly viewing SNFs as strategic partners, the DON’s influence is just as vital…