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Dipping or Diving: Trauma-Informed Care Expert Has the Answers

Spotlight
November 7, 2019

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Phase 3 of the revised Medicare and Medicaid requirements of participation for long-term care requires skilled nursing homes (SNFs) to provide “trauma-informed care” (TIC). Whether facilities and practitioners are dipping their toes in this or diving in head-first,...

Society Advocacy Helps PALTC Clinicians as CMS Releases Medicare Physician Fee Schedule and Quality Payment Program Final Rules

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Payment, Alternative Payment Models (APM), Medicare Access and CHIP Re-authorization Act (MACRA), Merit-Based Incentive Program Payment System (MIPS), Quality Payment Program (QPP), Practitioners
November 7, 2019

On November 1, 2019, the Centers for Medicare & Medicaid Services (CMS) released the CY 2020 Medicare Physician Fee Schedule and Quality Payment Program (QPP) final rules. Below is a summary of some of the policies CMS finalized.

Physician Fee Schedule (PFS)

CY 2020 PFS Conversion Factor

CMS is finalizing a series of standard technical proposals involving practice expense, including implementation of the second year of the market-based supply and equipment pricing update, and standard rate setting refinements to update premium data...

CMS Holding Some Skilled Nursing Facility Claims

Policy Snapshot
Patient Driven Payment Model (PDPM), Centers for Medicare and Medicaid (CMS), Payment, Practitioners
November 7, 2019

As the Centers for Medicare & Medicaid Services (CMS) has undertaken the implementation of the Patient Driven Payment Model (PDPM), it is holding a limited number of Skilled Nursing Facility (SNF) claims while making further refinements to its claims processing system.

Specifically, CMS is holding claims with:

  • Dates of service October 1, 2019, or later
  • Type of Bill (TOB) inpatient services (21X) and swing bed services (18X) subject to the SNF Patient Driven Payment Model (PDPM)
  • Multiple line items, Health Insurance Prospective Payment System (
    • ...

Bill Correctly for Medicare Telehealth Services

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Payment, Practitioners
November 7, 2019

In a recent report, the Office of Inspector General (OIG) determined that the Centers for Medicare & Medicaid Services (CMS) improperly paid practitioners for some telehealth claims associated with services that did not meet Medicare requirements. CMS released the Medicare Telehealth Services Video to help you bill correctly. Additional resources:

  • ...

Ambulatory Care–Sensitive Conditions Associated With Potentially Avoidable Hospital Admissions

JAMDA
November 7, 2019

Hospitalized nursing home residents have more chronic conditions, higher levels of care needs, and more unplanned admissions compared to non–nursing home residents.1,2 Unplanned admissions are admissions at out-of-hours care—thus, in the evening and night hours, and on weekends and holidays. However, evidence suggests that some of these unplanned admissions are potentially avoidable.3,4

The Longitudinal Associations of Handgrip Strength and Cognitive Function in Aging Americans

JAMDA
November 6, 2019

Factors that are responsible for age-related neurologic deterioration of noncognitive and cognitive processes may have a shared cause. We sought to examine the temporal, directional associations of handgrip strength and cognitive function in a national sample of aging Americans.

Effects of a Multicomponent Frailty Prevention Program in Prefrail Community-Dwelling Older Persons: A Randomized Controlled Trial

JAMDA
November 6, 2019

To examine the effects of a multicomponent frailty prevention program in community-dwelling older persons with prefrailty.

Evolution of the Nursing Home Industry in States With Different Certificate of Need Policies

JAMDA
November 5, 2019

One of the earliest efforts to curb needless health care spending in the United States was certificate-of-need (CON) programs, which limit and manage the expansion of different health care institutions. CON programs mainly targeted nursing homes and home health industry that provide long-term care that is predominantly financed by states through Medicaid program. A large set of empirical studies documented that CON laws have been unsuccessful in limiting growth of hospital,1,2 nursing home,3,4 and home health5,6 spending.

State Variability in Assisted Living Residents’ End-of-Life Care Trajectories

JAMDA
November 5, 2019

A growing and increasingly vulnerable population resides in assisted living. States are responsible for regulating assisted living and vary in their requirements. Little is known about how this variability translates to differences in the dying experiences of assisted living residents. The objective of this study is to describe assisted living residents’ end-of-life care trajectories and how they vary by state.

Diagnostic Accuracy of the SLU AMSAD Scale for Depression in Older Adults Without Dementia

JAMDA
November 5, 2019

To evaluate the diagnostic accuracy of a short depression screening tool, the Saint Louis University (SLU) AMSAD depression scale, relative to the Geriatric Depression Scale–15 (GDS-15) and Montgomery-Asberg Depression Rating Scale (MADRS), and in relation to the Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5) criteria for major depressive disorder, in cognitively intact older adults.