Category: Medicare and Medicaid

Justice Department Zooms in on Elder Financial Abuse

Financial exploitation of the elderly is a nearly $3 billion business annually, depleting the resources of many, including businesses and the Medicare and Medicaid programs. In hopes of curbing this fraud, the U.S. Department of Justice (DOJ) launched the Elder Justice website this week. “The launch of the Elder Justice website today marks another milestone… Read More »

Another Pioneer ACO Calls It Quits, Citing Regional Challenges

A 10th Medicare Pioneer accountable care organization (ACO) is throwing in the towel, following other ACOs that previously left in favor of other Medicare saving opportunities or dropped out of the ACO program altogether.  Sharp HealthCare, a five-hospital system in San Diego, announced it was leaving the Pioneer ACO program in its third-quarter financial statement. Sharp… Read More »

Maine Rallies for Totally New Approach to Senior Care

Maine seniors, along with affordable housing, home care, general contractors and other aging services stakeholders are rallying around a comprehensive package of proposals that aim to strengthen the state’s aging in place resources that go beyond traditional assisted living and nursing homes.  Mark Eves (D-North Berwick), speaker of Maine’s House of Representatives, last week unveiled… Read More »

House Calls Cut Medicare Costs 17%, Still in Vogue for Senior Care

A popular arrangement in the past where physicians provided care to patients within the comfort of their own homes, house calls haven’t completely gone out of style just yet, especially given their proven effectiveness in saving money for healthcare providers and federal programs alike, a recent study finds. Researchers with MedStar Washington Hospital Center, a 926-bed teaching and… Read More »

Why Home Health Care’s Growth Will Falter

As the desire to age in place increases alongside the aging population, the home health care sector will create nearly a million new jobs by 2022, far outpacing the growth of other major occupations in the U.S., The Wall Street Journal writes in a recent article.  The U.S. Department of Labor predicts the profession will… Read More »

CMS Oversight Creates ‘Unnecessary Burden’ for Providers

A government watchdog agency is calling for more oversight from the Centers for Medicare & Medicaid Services (CMS), which may “create an unnecessary burden” on some senior housing providers, a report finds.  The U.S. Government Accountability Office (GAO) found that CMS has not been effectively tracking postpayment Medicare claims to ensure the same claim isn’t… Read More »

Nursing Homes Rank as Worst Setting For End-of-Life Care

Reported care experiences are typically worse in the nursing home setting, according to the latest results of a survey by the Centers for Medicare & Medicaid Services (CMS). The Hospice Experience of Care Survey measured experiences of patients and their caregivers in three hospice settings: nursing home (including both skilled and regular nursing facilities), home… Read More »

Home Health Care Reduces Skilled Nursing Stays, Medicare Cost

Home-based primary care (HBPC) contributes to fewer skilled nursing facility (SNF) stays and reduces Medicare costs for ill seniors, a new report finds. A HBPC model led to 27% fewer SNF stays and 17% lower total Medicare costs over two years based on the study’s elderly participants, according to the report “Effects of Home- Based Primary Care on… Read More »

CMS: Skilled Nursing Faces Uncertain Future, Negative Margins by 2040

By 2040, two-thirds of skilled nursing facilities will be operating in the red, signaling more consolidations, partnerships and accountable care organizations (ACOs) on the horizon, according to a recent memo issued by the Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary.  Projections show skilled nursing, which has been declining in resident count according to the latest… Read More »

Minnesota Ranks Best State for Health ROI

As reforms in Medicaid and Medicare reforms sweep the nation, data show some states do better than others when it comes to health-related return on investments (ROIs). When considering death rates, American’s Health Rankings and average individual health insurance premiums, Minnesota stands out above other states as having the best overall health-related ROI, according to a recent study… Read More »

Skilled Nursing Reimbursements To Rise $750 Million in 2015

The 2015 skilled nursing facility prospective payment system (SNF PPS) will receive a boost in Medicare reimbursement, to the tune of an estimated $750 million in aggregate payments, according to The Centers for Medicare & Medicaid Services’ (CMS) final rule on Medicare payments for skilled nursing. The 2% Medicare rate increase in reimbursements represents a higher payment update factor… Read More »