Sights and Sounds from Roaring Reimbursement

The Annual Zimmet Healthcare Conference “Roaring Reimbursement” once again provided the most up to date information on the status of the SNF industry. The industry is battling immense staffing challenges combined with the increased penetration of Managed Medicare.

Among the key reimbursement related themes of the conference presented by the Zimmet team were:

1. Managed Medicare penetration is increasing virtually everywhere around the country. Managed Medicare means lower reimbursement, shorter LOS, and increased administrative tasks compared to traditional Medicare. This trend is directly affecting the bottom line of most SNF operators.
2. For Managed Medicare plans that use Levels, the plans place most SNF patients into the lower reimbursed categories of Levels 1 and 2.
3. Even though total Medicare beneficiaries are increasing, traditional Medicare enrollees are declining.
4. A very small percentage of SNFs make over 50% of the industry’s profit, while a 2/3 majority are losing.
5. From the perspective of PDPM, depression capture is still a major issue. 25% of the SNFs are still at 0% depression capture.
6. The transition from the PHQ-9 to PHQ-2 is coming and will change the way mood distress is captured to the tune of upwards of $40ppd in the nursing component. This could also affect CMI depending on the state.
7. As states transition their case mix systems from RUGs to PDPM, standardization will occur.
8. Although Medicaid reimbursement has increased in some states, it is still largely based on cost instead of care.
9. Many States are still 2+ years behind on completing annual surveys.
10. The role of Rehab is changing from reimbursement to care and quality.
11. Improved use of technology can play a big impact using Rehab in an entirely new way.

As good as the reimbursement aspect of the conference was, the Zimmet team really shined on the topic of Minimum Staffing:

1. A CMS study from 2001 recommended a 4.1 staffing ration to “avoid risk and harm.”
2. CMS has not acted on this study for 20+ years.
3. The Biden Administration commissioned a study in 2021. Still waiting on the results.
4. State level mandates range from 3.5 to 4.1 with the definition of direct care staffing still a moving target.
5. New York State is retroactively placing fines on SNFs who were out of compliance with minimum staffing from 2022.

The team at Language Fundamentals greatly appreciates the annual opportunity to learn and network thanks to the entire Zimmet organization.

If you’d like to speak about Speech Therapy Service, Rehab Therapy, or Reimbursement for your Skilled Nursing Facility, please don’t hesitate to contact us.