CMS Data

Skilled Nursing News reported industry apologists complaining about data on nursing homes on

Marc Zimmet, president of Zimmet Healthcare Services Group, is a well known industry apologist who defends nursing homes in civil litigation after the neglect and abuse of vulnerable adults caused by unsafe staffing and siphoning of taxpayer funds. He argues that the data on CMS is “borderline useless”. Of course, he relies on self-reported data to defend his nursing home clients.

Zimmet suggests the CMS Medicare cost report should include data on “Medicare Advantage”.  In the meantime, Zimmet says the Medicare Payment Advisory Commission (MedPAC) “should be ashamed of themselves” and that their data is “borderline useless”. Zimmet admits the data is available but claims it is too difficult for him to understand because of its complex nature.

MA enrollees have increased by over 11 million over a 16 year period, going from 7 million in 2006 to 28.8 million in 2022. MA utilizes Hierarchical Condition Coding Risk Adjustment Factor (HCC-RAF) scoring, a system designed to calculate rates per member per month. A higher score corelates to a higher monthly payment. The model being used depends on the care setting. MA uses demographic info, including sex, age, location, original eligibility for Medicare, and acuity in calculating scores.