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    October 03, 2024 Customer Newsletter

    By   ·  2 minute read

    memphis_tennessee_in_2024_detailed_color__c9b45ee3-19c9-40a0-baf7-2a483f1232de_0

    • Lower Medicare Expenditures

    • Time to Ace the ABFM Exam

    • Site-Neutral Payment Policy Divide

    • Nursing Homes Without Medical Directors

    New Report: Private Equity-Affiliated Physician Practices Associated with Lower Medicare Expenditures

    A new report is being used to promote lower Medicare expenditures (this press release is based on the report). Whenever you try to simplify complex care systems (which include all IM subspecialties), you tend to get into some tricky details. The study from Avalere does a good job of navigating these complexities, but there are some details the press release misses. It’s worth looking directly at the study.

    New Report: Private Equity-Affiliated Physician Practices Associated with Lower Medicare Expenditures - PR Newswire

    Medicare Service Use and Expenditures Across Physician Practice Affiliation Models - PDF Link

    memphis_tennessee_in_2024_detailed_color__e119797a-5b11-4e01-9a6b-dividerABFM There is still timememphis_tennessee_in_2024_detailed_color__65cd3412-8139-438c-8abd-dividersWhere Industry Groups Stand on Site-Neutral Payments

    There are no real surprises in this overview of who is lobbying for and against site-neutral payments, except that this time, unlike in 2008, the insurers are not on the hospitals' side. I wouldn’t classify them as being fully on board with site-neutral payments; rather, they’re trying to shift some services out of hospitals and into less expensive settings. They aren’t the doctors' friends here. MedPAC is aiming for something similar—lowered reimbursement rates. The fight is on, and it’s a great time to be a lobbyist in DC.

    Where Industry Groups Stand on Site-Neutral Payments - Beckers ASC 
     

    NL divider mindframe_summer_in_memphis_tennessee_in_2024_detailed_color_36% of Nursing Homes Had No Medical Director Presence in 2023

    Skilled nursing facilities are 65% Medicaid-funded, which means funding varies state by state. Medicare payments are limited in both dollars and duration. A study showed that over a third of nursing homes had no medical directors present in the first quarter of 2023. Among those that did, the average presence was just 36 minutes a day. For-profit and nonprofit facilities varied by 10%, with for-profits having the lowest medical director presence.

    Not in the article - 30% to 40% of COVID-19 deaths were in nursing homes and long-term care facilities (CDC report).  The excess mortality rate reported by the National Bureau of Economic Research (NBER) was 20% to 25% above normal mortality rate.

    One quarter of nursing homes are not compliant with infection prevention protocols for healthcare-associated infections. The CMS has introduced new staffing requirements and reporting mandates, accompanied by fines, but no additional funding to meet these new standards—resulting in an estimate that 80% of facilities will fail to meet them.

    Currently, 15% to 20% of the nursing workforce—including RNs, LPNs, LVNs, and CNAs—is employed in long-term care. The expected growth rate for both nursing facilities and home health/home care services is projected at 5% to 7% annually through 2031 (Bureau of Labor Statistics).

    We are busily manufacturing a disaster.

    36% of Nursing Homes Had No Medical Director Presence in 2023 - Beckers Hospital Review

    HHS-OIG Audit Suggests 1 in 4 Nursing Homes Are Not Compliant with Infection Preventionist Requirements - HIPAA Journal

    Senator Cramer Delivers Floor Speech on Unworkable Nursing Home Rules, Bureaucratic Intransigence at CMS - Senate.GOV
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