Data is quickly becoming a must-have for skilled nursing providers looking to shore up their post-acute business. Post-acute patients generally have high-acuity needs that result in higher daily reimbursements, usually by Medicare. As some hospitals and Medicare Advantage plans increasingly bear more financial risk for these patients, they will seek partnerships with providers that can demonstrate their ability to provide a high level of care and potentially avoid costly rehospitalizations. With the entry of other risk-bearing entities, such as accountable care organizations, into the marketplace, the need to demonstrate value will grow.
In the last major release of employment conditions prior to the upcoming meeting of the Federal Reserve on December 13 and 14, the Labor Department reported on Friday that nonfarm payrolls increased by 178,000 positions in November. Hiring has now averaged 180,000 new positions per month over the past eleven months. The year-to-date average was down from average monthly gains of 229,000 in 2015. Nevertheless, since 2010, nearly 15 million jobs have been created. The November gain was on par with the 180,000 consensus projection. The change in total nonfarm payroll employment for September was revised up from 191,000 to 208,000, and the change for October was revised down from 161,000 to 142,000. With these revisions, employment gains in September and October combined were 2,000 less than previously reported.
Setting business strategies for an unclear future continues to challenge many in seniors housing and care. It’s an issue that multiple sessions at the 2017 NIC Spring Investment Forum, March 22–24 in San Diego, CA, will address.
“It begins to sound like a broken record, but for years we’ve been anticipating this vast tidal wave of aging seniors,” said NIC CEO Bob Kramer. “That tidal wave is now nearly here, and time’s running out for everyone in seniors housing and care to put in place strategies to care for them efficiently, effectively, and profitably.”
Understanding the full value the industry has to offer seniors and stakeholders alike will be critical for operational success in the future, he said. “There’s additional value to be unlocked.”
Of the 99 largest metropolitan markets that the NIC MAP® Data Service (NIC MAP) tracks across the nation, 11 are located in California. Within these metropolitan markets, NIC tracks 870 seniors housing properties with 101,000 units, or nearly 12% of the seniors housing units regularly followed within the 99 markets by NIC. By coincidence, this share is comparable to California’s 12% share of the total U.S. population (38.8 million people live in California versus 320 million in the U.S. as of 2015). Within the state, performance measurements vary considerably.
In short, California is a state to watch when it comes to tracking the seniors housing market. Let’s take a closer look.
Skilled nursing operators—and those who invest in the sector—are no strangers to challenges. Over the past few years, government, payor, and operator initiatives across the country have been working to create a new health care delivery and payment system, and these initiatives are expected to continue for the foreseeable future. In fact, some industry leaders suggest that it could be two years until we see a narrowing of networks and partner alignment that will expose the winners and potential losers of the emerging system.
So what will happen in the meantime? One possibility is that we’ll see more consolidation within the sector over the next few years.
David Gruber, MD, MBA, Director of Research and a Managing Director with Alvarez & Marsal Healthcare Industry Group, recently authored a timely, interesting, and provocative report entitled, “Post-acute Care: Disruptions (and Opportunities) Lurking Beneath the Surface.” The report provides a perspective on the rapidly aging U.S. population, the evolution of payment reform, and the implications of these changes on the post-acute care sector. Increasingly, payors, providers, and investors are being affected by the ongoing consolidation of hospitals, health systems, and physician practices, as well as the emergence of advanced payment models that are changing the competitive landscape among all post-acute care providers. The author writes: “With healthcare moving away from facility-centric reimbursement, the post-acute care sector is facing an inflection point that will produce clear ‘winners’ and ‘losers’. Our analysis is intended to help operators take the steps they need to stay competitive and continue serving patients, a necessity as the U.S. population ages and requires healthcare institutions that can meet a complex array of medical, behavioral, functional and social needs.”
In the last major release of economic conditions prior to the presidential election on November 8, the Labor Department reported on Friday that nonfarm payrolls increased by 161,000 positions in October. Hiring has now averaged 181,000 new positions per month over the past 10 months and 176,000 per month over the past 3 months. The year-to-date average was down from average monthly gains of 229,000 in 2015. Nevertheless, since 2010, nearly 15 million jobs have been created. The October gain was less than the consensus projection of 175,000 positions.
The U.S. Government Accountability Office (GAO) concluded an investigation into data from the Centers for Medicare & Medicaid Services (CMS) on nursing homes, staffing practices, and financial performance by recommending that CMS make such data more easily accessible by the public and ensure the data’s validity. In the course of the investigation, the GAO revealed insights about margins and operations relative to the skilled nursing properties’ organization types. The agency’s report underscores the need for more and better financial skilled nursing data in the industry.
The push toward value-based purchasing by the Centers for Medicare and Medicaid (CMS) means significant changes for operators, said Ray Thivierge, a well-known and respected skilled nursing industry leader. He moderated “The Ever-Changing World of Skilled Nursing: The Impact of CMS Initiatives,” a session at the 2016 NIC Fall Conference in September. The session’s panelists were: Trissie Copses Farr, senior vice president, Formation Capital Healthcare Group, LLC; Jason Feuerman, SVP, Strategic Development & Managed Care, Genesis HealthCare, Inc.; Dr. David Gifford, Senior Vice President, Quality and Regulatory Affairs, American Health Care Association; and Nanci Wilson, vice president, R&D, Plum HealthCare Group, LLC.
Thivierge told conference attendees that aggregated payments to the nation's 15,700 nursing homes equal $110 billion. Of that amount, 80% or more is derived from two public sources: Medicare and Medicaid. Because such a high percentage of payment comes from Medicare and Medicaid, nursing care operators must pay close attention to the CMS push to reduce costs through value-based purchasing.
The preliminary 2016 third-quarter data is in, and it shows that transaction volume continues to slow down in 2016. Public buyers, mainly the public REITs, have led the slowdown, as cost of capital increased, and the number of transactions that suit their strategies declined. But on the private side, buyers continued to stay relatively active in the third quarter.