Elise Smith

Recent Postings from Elise

January 2019

SNFs Face Steep Challenges in 2019

Elise takes a comprehensive look at the implementation of PDPM this year, CMS quality programs, Medicaid and Medicare managed care and more.

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December 2018

Are Your Ready for FY 2020?

Elise takes a closer look at what's ahead in a busy year for skilled nursing facilities and the role of both CMS and MedPAC in the upcoming policy debates.

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August 10, 2018

SNF PPS Final Rule: CMS Approves PDPM

As expected, CMS issued the final rule for the SNF PPS for 2019, including the move to the new Patient-Driven Payment Model. Elise explains what this means for nursing homes, as well as what it may mean for LTC Pharmacies and consultants.
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July 3, 2018

MedPAC Supports PDPM and Releases June Report

The comment period for the CMS proposed rule on SNF payments for 2019 closed on June 26. Elise reports that MedPAC supports the CMS proposal and gives us some insight into the Commission's June report.

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May 10, 2018

CMS Proposes Patient Driven Payment Model for 2020

CMS issued a proposed rule for SNF payments for 2019 and included a proposal for a major change in the way it pays Skilled Nursing Facilities under Medicare Part A. Elise provides us a comprehensive look at what this new system is an how it's likely to affect our industry.

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April 25, 2018

MedPAC Addresses A Key Element in the Uniform PAC PPS

As you know from Elise's previous updates, the Medicare Payment Advisory Commission has been studying the process of moving toward a unified post-acute care prospective payment system. Sound simple? Not so fast. Elise explains the issues MedPAC is considering in this latest update.
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March 16, 2018

Medicare Bundled Care and SNFs

Under the Trump Administration, CMS has created a new bundled care program in Medicare. Out with the old and in with the new. Elise gives us the history of bundled care and explains the implications of the latest effort to come out of CMS. Read this and you will be thoroughly versed in a difficult but important subject that impacts your customers.

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February 15, 2018

Key Issues for Long-Term Care in 2018

If you've been paying attention, you should be aware that nursing homes are experiencing declining census numbers, but the regulatory environment for SNFs continues to increase in complexity. If you've had trouble keeping it straight, take a deep look at Elise's insights this month as she takes us through all the challenges facing the industry we serve.

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January 16, 2018

MedPAC Calls it a Wrap!

Elise reports on the January meeting and finalizes its recommendations to Congress for payment policy in 2019. This is the annual ritual where the Commission assembles its mountain of data and tells Congress which providers, in its estimation, are being overpaid, underpaid and how payments could be improved.

As usual, MedPAC thinks nursing homes get paid too much under Medicare and has some recommendations. I won't spoil the story, so if you want to know what they think, read more.

November 30, 2017

CMS Final Rule: Knee Replacement no Longer Inpatient Only

Elise reported earlier on the CMS proposed rule to remove total knee replacement from the list of "inpatient only" procedures under the Medicare Outpatient Payment System. The agency has finalized the rule, which means that recipients undergoing outpatient knee replacement will not have a 72-hour hospital stay in order to qualify for Medicare Part A rehabilitation in a SNF.

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October 30, 2017

Keeping an Eye on MedPAC

Elise points to the increasing demands being placed on nursing homes and turns her attention to recent research presented to MedPAC concerning Medicare beneficiaries tendency to choose low-performance nursing homes. Elise provides some background on this issue, noting that hospitals are generally prohibited from recommending SNFs to patients being discharged.

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September 12, 2017

Proposed Changes to the Inpatient Only Rule could impact SNFs

CMS recently published a proposed rule on Hospital Outpatient Payment System updates and asked for comments on allowing hip and knee replacements to be performed in outpatient settings. Elise discusses the implications on nursing facilities if Medicare beneficiaries stop using SNFs for rehabilitation.

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July 11, 2017

Getting to a Unified Post-Acute Care Payment System

Various Federal agencies have been working for years to come up with a unified payment system for post-acute care (PAC). In this paper, Elise gives us a much-needed history of the policy and its development, featuring the star players CMS and MedPAC.

Why should you care? Your PAC customers have a lot riding on how the drama finally resolves. They care about this, and so should we. See more here.

June 20, 2017

CMS Reverses Its 2016 Position on Pre-Dispute ArbitrationCMS Reverses Its 2016 Position on Pre-Dispute Arbitration

On June 8, 2017, CMS issued a proposed rule that reversed its position prohibiting pre-dispute arbitration agreements in long term care facilities. This was the culmination of policy making and unmaking that, with respect to the latest clash on Skilled Nursing Facility/ Nursing Facility arbitration practice, started on October 4, 2016. See more here

May 8, 2017

CMS Releases Proposed Rule for FY 2018 PPS Payments

Ah, Spring! The flowers in bloom, the pollen in the air and CMS releases its annual notice of proposed SNF PPS rates for the coming fiscal year.

Although this normally strikes terror in the hearts of the policy-consuming public, fear not. This year we are fortunate to have Elise Smith's summary of this important document at our disposal. Take a look at Elise's take.

CMS Announces Proposal to Modify SNF PPS Case-Mix Methodology

While you have been frolicking over these past several years, CMS has been steadily preparing an assault on the status quo as it relates to Medicare payment policy for SNFs under Part A.

According to another insightful analysis by Elise, CMS suspects SNFs have been gaming the RUGs system and proposes a new payment methodology based on more "objective" standards than the number of rehabilitation hours a resident will require. Read this and your confusion over the new proposal will vanish like your paycheck in Las Vegas.

April 2, 2017

The MedPAC March Report: MedPAC's Role in Public PolicyThe MedPAC March Report: MedPAC's Role in Public Policy

The Medicare Payment Advisory Commission was created to advise Congress on Medicare payment policy. This agency is a mystery to many of us. Thankfully, Elise Smith once again makes the opaque transparent with an excellent overview of the Commission's March report, as well as helpful background on the role MedPAC plays in post acute care. Read Elise's Post.

March 17, 2017

Implementing the CMS LTC Final Rule: Where are we?

Remember our anxiety, waiting for CMS to release its final rule on LTC Requirements for Medicare and Medicaid? We all (mostly) read the rule eagerly, looking to see how hard life was about to become for the nursing home industry.

A few months have passed since then. So, where is the industry on implementing all those very expensive requirements? Elise Smith has, once again, been talking with the movers in the industry and files this informative report.

February 20, 2017

Nursing Home Policy Priorities in 2017

The new year is upon us, and with it another year of triumph, near misses and major disappointments. So, what keeps our friends in the nursing home industry awake at night?

Take a look at Elise's take on the major policy issues facing the industry in the months ahead.

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