RCS-1 Gets Personal

CMS has released a spreadsheet showing the estimated change in Part A reimbursement under RCS-1 for every SNF in the US. There are a few surprises.

The biggest surprise is that the data used to make the estimates is much fresher than we're accustomed to. Normally it takes at least a year to get any data from CMS. This data appears to be ending last October. I'm not reading anything into that, but it's new.

What's not surprising is the impact to SNFs. In the technical document released with RCS-1, Accumen and CMS said that small and government owned homes would see increased reimbursement and homes doing a lot of UH would see a decrease. 

In the graphic below (click to enlarge), you can see that's exactly what's happening. Small government homes see an average increase of $96.51 (!) per Med A patient per day. For-profit SNFs with more than 200 beds see an average decrease of $3.26 per Med A patient per day. The size of the box represents the number of utilization days for the category. The largest category is for-profit homes with between 100-149 beds. Those facilities are estimated to see an increase of $2.01 per Med A patient per day.

Here is the same data in table form. Some may find it easier to understand. It also includes rural versus urban. As you can see rural facilities fare better than urban. (click to enlarge)

By State

The map below aggregates the data by state. The top number indicates the change in average PPD for a Med A patient. The bottom number is the total number of Med A days utilized in the state. Since RCS-1 pays high utilization providers less, the map also can be used to tell where utilization is high.  (Click to enlarge) This map doesn't do much to reduce the perception some in the industry have regarding Florida.

If your facility is seeing an increase, thank Florida!

By Facility

Don't let that map fool you though. Just because you're in a green state doesn't mean you'll see an increase in PPD. Check out this image of Illinois, which has an average PPD increase of $9.90.

There are still a lot of facilities in the red. As CMS stated, urban areas fair worse that rural. Small facilities do better than large. This map really shows that well. Chicago is particularly hard hit.


The real value in this data is that you can look at any facility and get a good idea of what RCS-1 might mean for you and start planning!

Here's an example: This is Salisbury, North Carolina. I've mapped the individual facilities in town. I'm showing the average change in Med A PPD, the total change in Med A for the year and the number of Med A days. for every facility in town. (Click to enlarge)

As you can see, there is a lot going on in a small town. One for-profit, Autumn Care is projected to see an increase of nearly a quarter million per year in Part A while across town another for-profit, The Laurels, is projected to lose nearly $190K. Meanwhile the Veterans Home downtown is expected to increase by $130K annually.

If you are in skilled nursing, you need to be aware of and understand the implications of a change this large. I can't emphasize this enough. The dynamic of your local marketplace will almost certainly change if RCS-1 goes through as proposed! Do not ignore this! You need a plan. 

As always, I am here to help. Give me a call today. I'd be happy to give you your projection and talk about ways to improve your situation, regardless of which way your Med A is headed.