Monthly Archives: February 2016

Quoted from McKnights News February 19, 2016 … “A bill that aims to ease the overwhelming backlog of Medicare appeals would cost the federal government more than a billion dollars, according to a cost estimate released Tuesday. The Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act (AFIRM Act) of 2015 would cost $1.7 billion over the next ten years if it is passed in 2016, the Congressional Budget Office estimated in its report. The bill was formally introduced…..

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A recent posting in McKnights daily news states: Each facility’s data “story” should have cost analysis, payments, length of stay, outcomes and discharge site for specific diagnosis codes, comorbidities and physicians. The skilled nursing facilities that use data to positively differentiate themselves will perform best under advanced payment models, Chris Murphy, CPA, a partner at BKD Consulting said. Once providers have their data story ready to share, Murphy advises sharing it with the hospital’s chief nursing officer, chief financial officer…..

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The Medicaid and CHIP Payment and Access Commission is increasing its effort to present offset options when it advises Congress on funding and policy changes to the federal healthcare programs serving low-income people and children. The scrutiny comes as Medicaid, the nation’s largest insurer, is experiencing severe growing pains. The number of enrollees has jumped from about 50 million in 2010, the year the Affordable Care Act was signed into law, to more than 70 million today. Medicaid spending hit…..

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In the past and currently cost accounting for our products (service units of output) have not been used as a measure of quality or payment. Therefore all the incentives are negative by forcing health care to be creative in picking the right codes to maximize our revenue streams that trend to being inadequate because of the imposition of more and more overhead costs related to the regulatory nightmare are designed to keep the patients and families in the dark ……..

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“As many more new orthopedic bundles will soon be coming on the market under CMS value-based payments this April, post-acute care providers need to be talking with the hospitals – or bundle initiators or leads – in the planning stage, and not wait to be the downstream vendors with lots of imposed expectations but no part in the planning (or participation in the risk)”. “The established benchmark for rehabbing patients participating in the bundles for this practice were between 5…..

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CMS expects 30% of the referrals to be bundled by mid-2016 and 50% mid-2017 and 100% thereafter. The long term care market has committed more providers to the demonstration projects than hospitals and physician groups but they are the least prepared.  As of yet their software hasn’t been designated as meaningful use for interoperability and standardizing the processes. The old referral process is gone.   Discharge planners are no longer the point people for your census development. It is the finance…..

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Traditionally reimbursement has moved to PPS for Medicare and managed care for Medicaid, while the long-term care insurance market is shrinking due to operational losses.   As bundled payment (physician, hospital and LTC components under one umbrella) and episodic pricing (acute, sub-acute, skilled nursing, assisted living home care, hospice) take over the reimbursement model with a pricing model the continuum is at risk for outcomes (length of stay, cost per episode, quality of life for the patients as demonstrated by satisfaction…..

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The author in today’s McKnights of the above titled article believes that mistrust is a problem … And I agree that long-term care mistrusts Government for good reason, but underfunding  is THE problem. There will never be enough money when the surveyors and State and Federal Governments are head hunting so they don’t have to take any responsibility for underfunding minimum standards that become maximums. If anyone feels more laws, regulations and fines will solve the problem, after 35 years of frustration, go…..

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The following was reported in the McKnigths news, February 4, 2016 Hypoglycemia and care transitions are among the topics in the first-ever guidelines relating to diabetes management in long-term care facilities. “Management of Diabetes in Long-term Care and Skilled Nursing Facilities,” released Tuesday by the American Diabetes Association, highlights the differences in diabetes management for younger and older people. The guidelines primarily focus on type 2 diabetes, since the majority of diabetic long-term care residents have that type, according to…..

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The results of CMS’ “Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents” for calendar year 2014, released Wednesday, showed that Medicare expenditures were generally reduced at all seven testing sites, relative to a comparison group. Two sites showed “statistically significant” reductions in expenditures. Blogger comment: Two sites out of seven (28.5%) showed “statistically significant” reductions in expenditures.  What about the other (71.5%) sites.  Sounds like a spin to me how about you. Umm.  Reduction in expenditures but what they…..

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