Archive for February, 2019


Nursing Home Study: More Medicaid Patients=Worse Care

Nursing homes that serve larger proportions of Medicaid patients have lower quality ratings, according to a new study from the American Health Care Association, a long-term-care provider trade group.

The study also found that:

  • For-profit nursing homes care for more Medicaid patients than non-profits.
  • Rural nursing homes care for more Medicaid patients than urban facilities.
  • Large facilities care for a higher proportion of Medicaid patients than smaller facilities.


Learn more about the study and the theories behind some of these findings in the McKnight’s Long-Term Care News article “AHCA study: Facilities with higher Medicaid populations have poorer quality outcomes.”


OIG: Medicare Errs in Paying for Some Skilled Nursing Care

Medicare is erroneously paying for skilled nursing facility care for beneficiaries who did not spend three nights in an acute-care hospital, the U.S. Department of Health and Human Services’ Office of the Inspector General has concluded.

Based on a limited sampling, the OIG estimates that Medicare spent $84 million on such ineligible services from 2013 through 2015.

A new report from the OIG explains that

We attribute the improper payments to the absence of a coordinated notification mechanism among the hospitals, beneficiaries, and SNFs to ensure compliance with the 3-day rule. We noted that hospitals did not always provide correct inpatient stay information to SNFs, and SNFs knowingly or unknowingly reported erroneous hospital stay information on their Medicare claims to meet the 3-day rule. We determined that the SNFs used a combination of inpatient and non-inpatient hospital days to determine whether the 3-day rule was met. In addition, because CMS allowed SNF claims to bypass the Common Working File (CWF) qualifying stay edit during our audit period, these SNF claims were not matched with the associated hospital claims that reported inpatient stays of less than 3 days.

To address this problem to OIG recommends that

… CMS ensure that the

Nursing Home Occupancy Down

Nursing home occupancy fell from 83.07 percent in 2013 to 80.24 percent at the end of 2017, according to a new report.

The amount of time patients spend in nursing homes is falling as well.

Declining occupancy and length of stay and shrinking reimbursement have led to nursing home closings and a six percent decline in cash on hand between 2013 to 2017.

Learn more about some of the challenges facing skilled nursing facilities in the McKnight’s Long-Term Care News report “Dwindling reimbursement, occupancy numbers chipping away at skilled nursing margins, new analysis finds.”


Surprise Balance Billing Emerges as Issue in DC

Lawmakers on both sides of the political aisle are expressing interest in addressing the problem of surprise balance billing:  when insured individuals receive unexpected medical bills from providers for services for which they believe they are insured.

Surprise balance bills have been a problem for years, with a number of proposals offered in the past to address the problem.  Now, bipartisan support for a solution appears to be growing in Congress.

In a new report, the journal Health Affairs describes the issue, outlines balance billing proposals offered in the recent past, and describes the challenges members of Congress now face while trying to balance the needs of consumers, insurers, and providers.  See the report “Federal Policy To End Surprise Billing: Building On Prior Approaches” for more.…

Hospitals Continue to Employ More Docs, Buy Physician Practices

Between 2012 and 2018, the proportion of U.S. physicians employed by hospitals and health systems rose from 25 percent to 44 percent.

And between 2016 and 2018, 14,000 physicians left private practice behind to work for hospitals and health systems while those hospitals and health systems purchased 8000 physician practices.

One reason health systems employ physicians and purchase physician practices is enhanced reimbursement:  Medicare pays more for services provided in hospital outpatient settings than in private physician offices, although Medicare has been taking steps in recent years to reduce or end this practice through the introduction of site-neutral Medicare outpatient payments.

Learn more about the continued movement toward hospital-employed physicians in the Healthcare Dive article “Hospitals now employ more than 40% of physicians, analysis finds.”