David Sorkin

“The IPA is an optional assessment. In the eyes of Medicare, that is very clear,” Zimmet Chief Operating Officer Michael Sciacca said during a webinar last week. “What we’re hearing from some of our clients is that some of the insurance companies are requiring it when there’s a [positive] change in condition, which I would certainly push back on.”

“The requirement to continuously change reimbursement levels, that administrative burden was the whole point of making this assessment optional in the first place.”

Sciacca and Zimmet partner Vincent Fedele, who is also chief operating officer of CORE Analytics, said there continues to be confusion around this — even though some software systems are made to alert and potentially stop providers from submitting IPAs that lower their reimbursement.

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My happy place is standing in front of nursing home providers and honoring them through education. Shining a loving light on these special people and honoring their commitment to better care feeds my soul. So when Moshe Kelman asked me to present at his provider organization’s annual educational/holiday conference, I gleefully accepted.

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Providers still struggling to accurately capture diagnoses that drive federal reimbursement will be doubly left behind as more states start to use Patient Driven Payment Model-like systems to determine long-stay Medicaid pay rates.

That was the warning Wednesday from reimbursement experts Vincent Fedele, chief operating officer of CORE Analytics, and Michael Sciacca, chief operating officer at Zimmet Healthcare Services Group.

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Steven Littlehale MS, RN Chief Innovation Officer, Zimmet Healthcare Services Group was appointed to the Technical Expert Panel (TEP) for the Scoring Methodology for the Expansion of the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program

As a member of this TEP, Littlehale contributed direction and thoughtful input on the scoring methodology for the expansion of the SNF VBP Program. This work is in response to Section 111 of the Consolidated appropriations Act, 2021, which allowed the Secretary of the Department of Health and Human Services to apply up to nine additional measures to the SNF VBP Program for payment for services furnished on or after October 1, 2023 (fiscal year [FY] 2024). The purpose of this TEP is to solicit stakeholder input on updates to the SNF VBP Program scoring methodology to allow for applying additional measures to the current single measure Program. Updates can be found here.

As the SNF sector enters its third year under the Patient-Driven Payment Model (PDPM), data analytics and consulting firms like Zimmet Healthcare Services Group are finding stark differences in reimbursement levels between top-performing operators and those at the bottom of the barrel.

For one, the top 10% of SNF providers have rates $70 over the average, while the bottom 10% of providers are $70 below the average. The difference is buried in nursing and non-therapy ancillary services, according to Zimmet Director of Analytics and Partner Vincent Fedele.

Fedele, Sally Fecto, vice president of clinical reimbursement and COO and Partner Michael Sciacca presented data insight on PDPM trends and benchmarking during a webinar on Wednesday.

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A lot of temporary measures will dry up or disappear when the public health emergency (PHE) comes to an end, but one thing that may become permanent is the Medicaid rate bumps states put in place to alleviate pressures nursing home operators face.

At least that’s the hope for industry leaders and advocacy groups.

Right now there are 12 states that have Medicaid add ons currently tied to the end of the PHE, according to American Health Care Association/National Center for Assisted Living President and CEO Mark Parkinson.

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It’s a curious day when I lift a lyric from the Spice Girls to title an article. The Spice Girls’ first single, “Wannabe,” was released in 1996 and rocketed to the top of the British singles chart. “Wannabe” went on to hit number one in some 30 countries.

But this lyric is so perfect and reflects the key messages that the sensational Heidi Wold, chief clinical officer of Longevity Health Plan, and I presented this August at Zimmet Healthcare Services Group’s annual conference. Do you “wannabe” in a preferred network, have high occupancy, and most importantly, have excellent resident outcomes?

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The five-star quality rating system has been a thorny issue for a lot of operators in the skilled nursing space, with many calling for a significant overhaul to quality metrics as facilities drown in seemingly endless federal benchmark adjustments.

Even academics and consultants monitoring the sector believe the ratings system needs to be updated – the Convergence Center for Policy Resolution, for one, called on the Centers for Medicare & Medicaid Services (CMS) to base ratings more on resident and family lived experiences.

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As the Biden administration marches toward some type of minimum staffing requirement for nursing homes, it’s easy for providers to feel like helpless, angry victims. Even as a proponent of acuity-based staffing standards in some form, I too am annoyed.

How can we authentically work toward nursing home reform if our efforts are based upon decades-old staffing studies that don’t acknowledge the diversity of residents, specialization of providers and caregivers, and technologies in nursing homes today?

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