The Patient Driven Payment Model is a rare bright spot in Skilled Nursing’s dreary reimbursement landscape, but storm clouds are on the horizon. CMS has proposed recalibrating SNF rates to correct for unintentional spending relative to the RUG system it replaced. The agency refers to this reduction as a “Party” but in the context of a post-pandemic operating environment, the proposal reads more like a “Reimbursement Parody” to me…
White Papers & Articles
Marc Zimmet: The Medicaid Rate Construction Infrastructure Crisis
The codependent Medicare/Medicaid duopsony can no longer balance the SNF financial equation. Medicare Advantage, Alternative Payment Models, and ill-conceived experiments with Managed Medicaid LTC created structural deficiencies the current economic model was not designed to absorb.
Skilled Nursing was saved from pandemic distress by emergency federal funding. Now, in the face of comprehensive reform, policymakers must fortify the industry’s reimbursement foundation. Reliable data is essential for success; without it, a decades old incongruity threatens to destabilize the entire healthcare continuum.
Marc Zimmet: The CORE Reporter, October 2021
CORE analyzes current Medicare and Medicare Advantage claims to identify reimbursement opportunities and measure a facility’s value-proposition against its peer group. As of October 1, CORE tracks Medicare performance through August 2021, while the LDS does not extend past March. CORE also delivers the same standard LDS tools, but we believe providers should not be forced to pay for access to public data; we simply include the functionality as a handy value-added service.
Marc Zimmet: Medicare Advantage & SNF Reimbursement
The Rime of the New World Mariner:
It is a New World Mariner,
And he stoppeth wounded knee,
With long grey beard and rehab needs, Now wherefore stopp’st thou he?
Data, data everywhere,
Still all our rates did shrink, Data, data everywhere,
Yet all of it doth stink.
Survival of the SNFittest
A generation ago, SNFs were on the precipice of an epigenetic shift that would carry them beyond “subacute” care. They would offer managed care organizations a cost-effective alternative to hospitalizations. Facilities were renamed; more “D/B/As” were filed in 2001 than in all previous years combined. “Nursing Homes” became “Health & Rehabilitation Centers.” SNFs would create and lead Integrated Delivery Systems to the promised land known as “Healthcare Reform.” Alas, it seems that insurance companies, not to mention nature, have rules. No matter how far the SNF model of care progresses, people still struggle to see beyond their outdated image of “nursing homes.” A comparative search on Google Trends distills the essence of public perception. What will it take for skilled nursing facilities to finally evolve?
Read more below in Marc Zimmet’s “On the Origin of SPEOCCUPANCIES”
OriginsHappy ThankSNFing!
Thanksgiving is a time for gratitude and appreciation. But for those who endured the darkest days of this pandemic, it’s an opportunity to process, in groups of no more than 10 people, hardships that were unthinkable way back in the age known as BCE (Before the COVID Era). Yet there is good reason for optimism with a vaccine just weeks away, so let’s take a moment to reflect on what SNF operators can be thankful for this year.
Read Marc Zimmet’s “Happy ThankSNFing” message below:
Happy ThankSNFing!
THE COVID-EFFECT: A Comparative Analysis of April 2020 Medicare SNF Claims
COVID distribution reporting is subject to extreme bias for a host of reasons – first and foremost, the virus is selectively more threatening to the health-compromised elderly – a cohort that disproportionately resides in institutional settings. Statistically, introducing one person infected with the coronavirus to a nursing facility would produce outcomes that are non-comparable to introducing that same catalyst into Central Park on a warm spring day.
Projected v. Realized Performance in the Context of Healthcare Reform
Z-CORE Analytics, LLC and Zimmet Healthcare Services Group, LLC are pleased to present our latest observations based on November 2019 Medicare Part A claim data.
