After a 1.7 billion in nursing home payment increase, the federal government is mulling several options to recalibrate the Medicare payment structure for skilled nursing facilities as it seeks to achieve its intended goal of budget neutrality, with the aim of shutting off excess payments as soon as possible.
According to the National Investment Center for Seniors Housing & Care, skilled nursing facility occupancy hit a record low again in January; occupancy fell to a new low of 71.2%, dropping 0.4% below December’s numbers and 13.8% below pre-pandemic levels.
Medicare revenue per patient day (RPPD) declined from December to January, ending the first month of the year at $552, but that’s up from March of last year, when the RPPD was $549, according to McKnight’s Senior Living. This change likely is due to the fact that the federal government has been supporting Medicare fee-for-service reimbursement with higher rates to help care for COVID-19 positive patients requiring isolation. That support will change as SNF case counts decline sharply as vaccinations ramped up.
Under a proposal announced by CMS, nursing homes would receive a 1.3% net Medicare increase for fiscal year 2022, resulting in a $444 million aggregate pay boost in Medicare Part A payments for SNFs, according to McKnight’s Long-Term Care News.
CMS also is proposing a new quality measure that would require skilled nursing facilities to report staff COVID-19 vaccination rates starting Oct. 1, 2021.
Starting in January 2022, nursing home operators in New York will be required to return all profits in excess of 5% to the state while requiring operators to spend 70% of revenue on direct care, according to Skilled Nursing News. Governor Andrew Cuomo said excess revenues recouped by the state will be deposited into the existing nursing home quality pool for further investments for nursing homes to meet high quality standards.
Mark Parkinson, president and CEO of the American Health Care Association, is hopeful that skilled nursing occupancy will recover faster than anticipated. Industry-wide occupancy has been rising at about 100 basis points (1%) per month since January. The latest recovery trends suggest that the 1,200 basis-point drop in occupancy during the pandemic could be recovered within 12 months, according to McKnight’s Long-Term Care News.
As COVID-19 puts a new focus on caring in place, SNFs are exploring dialysis. The ability to treat patients in place can reduce unnecessary hospitalizations. For residents, treating in place prevents the hassle of going to and from the SNF to a new setting. For some operators, dialysis services present an opportunity for SNFs to expand their ability to treat patients in place and find their footing in a post-COVID world. By offering this service, SNFs can attract new patients who might need it, in turn, improving their census, according to Skilled Nursing News.
CMS is rolling out pilot testing of the new HOPE tool among a mix of hospice providers of varied sizes and geographical settings.
The tool will replace the Hospice Item Set (HIS) quality reporting system when completed, but providers have growing concerns about the ramifications, with many stretched thin after a tough year during the pandemic. The tool’s dual objectives are to provide data for the Hospice Quality Reporting Program through standardized data collection and provide clinical data that may inform potential future changes to Medicare hospice payments. CMS is working to develop measures for the HOPE reporting program that are compliant with the agency’s Meaningful Measures Initiative, according to Hospice News.
Last week CMS unveiled a pair of proposed rules that are likely to have significant ramifications for hospice and SNF providers nationwide. Hospices would see an estimated 2.3% ($530 million) increase in their payments under the provisions of the proposed rule, based on the estimated 2.5% inpatient hospital market basket reduced by the multi-factor productivity adjustment (0.2% point), according to RAC Monitor.