Skip Navigation

News & Updates



Problems related to reimbursements and payments, shortages in staffing, and the challenges that come with implementing new technology are plaguing healthcare service providers. Due to these struggles, providers are suffering financially. For more information read the article linked below.



This year has been a year of growth for BY&S. Our employees have welcomed new children and spouses and we have hired eight additional team members. As the company continues to focus on expansion, we set our sights on a second hub to complement our corporate office in Forest Hill, MD. In recent years we have developed a small concentration of employees in the Charlotte, NC area and it became clear to us that this was a place that would offer great opportunities for us to continue to grow the company. In August we began our search, and on October 1 we officially opened our second office within the Charlotte suburb of Matthews, NC. Located in the heart of Matthews’ historic downtown, the office is within walking distance to numerous restaurants, cafes, and small businesses. As we reflect on the growth of 2018, we are excited and look forward to our new office and the future. If you are ever in the Baltimore or Charlotte areas feel free to look us up!



Many financial changes will take place over the next year in the skilled nursing space, but one of the largest involves shifting payment incentives. Starting in October 2019, reimbursements will be based on treatment of the patient’s overall health issues instead of billable therapy hours. For a more in depth explanation read the article linked below.

Skilled Nursing Providers Have One Shot at Payment Success Under PDPM


Research is now suggesting that billions of dollars could be saved by replacing Long Term Care Hospitals (LTCHs) with Skilled Nursing Facilities (SNFs). Medicare could save at least 4.6 billion by making this change or by changing the payment structure at LTCHs to mimic those of SNFs. For more detail read the article linked below.

Replacing Long-Term Care Hospitals with Skilled Nursing Could Save Medicare $4.6B



Post-acute care providers, specifically skilled nursing facilities, are receiving a huge pay increase in the 2019 fiscal year. The total increase is over one billion with 820 million going to skilled nursing facilities. This increase is followed by overall policy changes for post-acute care providers. Read the article linked below for more details.



Medicare is cracking down on insufficient staffing in nursing homes using lowered star ratings. The result is nearly 1,400 nursing homes having a lower star rating than before based on this new standard. For more information read the article attached below.


The Centers for Medicare and Medicaid Services (CMS) is proposing to reduce the payment for hospital outpatient clinic visits provided at off-campus provider-based departments (PBDs). Since clinic visits are the most commonly billed services, CMS is expecting a significant reduction in spending in the 2019 fiscal year. See the article linked below for more details.


BY&S welcomes Erik Svilich and Matthew Camarata to our team of healthcare finance professionals. Erik previously worked part time as a field examiner while pursuing his degree in Finance from Portland State University and Matt previously worked as a field examiner in the non-healthcare space for the past two years. With the addition of Erik and Matt, BY&S expands its geographic presence into Portland, Oregon where Erik is located and Chicago, Illinois where Matt is located. We are excited to have Erik and Matt join our BY&S family.



Increasing healthcare costs drives employers to provide high-deductible health plans that shift a larger portion of the cost to the patient. This has caused an increase in unpaid patient balances resulting in significant bad debt burdens for providers. Find out more about this broken billing system in the article linked below.


Breslin, Young & Slaughter, LLC is excited to announce Leslie Fitchlee, Derek Watts, and Joseph Muller as three new additions to our team. Leslie is located in northern New York and brings four years of ABL experience in addition to fourteen years in various business and accounting roles to her new position at BY&S. Derek adds to our Charlotte, NC presence and comes to BY&S with four years of accounting experience. Joe is joining our corporate office after graduating Towson University and working for a year in mortgage lending. We are very happy to welcome all three of them to our BY&S family.


With changing reimbursements, staffing pressures, and regulatory scrutiny, the skilled nursing landscape is changing. However, there is still a role that REITs can plan in the long-term care industry. For more information see the article linked below.

REITs Adopt Novel Approaches to Stay Relevant in Skilled Nursing



Large skilled nursing portfolios are becoming available as the skilled nursing industry continues to experience declining occupancy, increases in managed care, and payment model changes. Find more details in the article linked below.

Larger Skilled Nursing Portfolios Hit Market as Sell-Off Continues


CMS has proposed a Patient Driven Payment Model (PDPM) which could go into effect next year. If this is the case, therapy companies will be forced to dramatically alter their business model. Find more information in the article linked below.

Rehab Business Model Will Change ‘Substantially’ Under PDPM


Skyline Health Care could be dissolving as a whole after many states have reported the company having financial problems creating medical risk. The latest news came from South Dakota where residents in 19 facilities were put at risk due to limited medical and food supplies. This caused the South Dakota Department of Health to put Skyline in receivership requiring them to turn over all assets and income. For more information see the article linked below.

Skyline Healthcare Collapsing in South Dakota, Could Dissolve Soon



With managed care growing and becoming more and more popular, skilled nursing providers may finally be getting some good news. The increase in managed care will give skilled nursing providers leverage when it comes to negotiating contracts in the future. For more details read the article linked below.

As Managed Care Grows, Skilled Nursing Providers Have Leverage


The skilled nursing industry continues to struggle and now it is more difficult to find financing. Traditional lenders are shying away from the industry and those that are providing financing are doing so selectively. However, there seems to be no shortage of capital for financing real estate deals. Find out more in the article linked below.

Traditional Lenders Take ‘Selective’ Approach to Skilled Nursing


While the news around the skilled nursing industry may not be positive as of lately, skilled nursing is still a much safer investment than hospitals. Some believe the perceived risk related to skilled nursing facilities is higher than the actual risk. Read the article linked below for more information.

Perceived Risk Hides Potential Upsides for Skilled Nursing Investors


A new Medicare reimbursement structure for therapy services rewards providers that take on higher-acuity patients. Skilled nursing operators are dubbing this transition a “game changer” for the industry. For more details read the article linked below.

New Therapy Payments a ‘Game Changer’ for Skilled Nursing Industry


Does a five star rating for skilled nursing providers mean what you think? There may not be a correlation between lower rehabilitation rates and five star ratings. The truth is there is as little as a three percent difference between five star facilities and one star facilities in relation to rehospitalization. Find out more in the article linked below.

High Five-Star Ratings Don’t Correlate with Lower Rehospitalization Rates



QPC-Manor Care deal results in QPC expecting to lose their real estate investment trust status while Manor Care enters bankruptcy protection. What does this mean for the skilled nursing industry? Find out in the article linked below.

QCP-ManorCare Deal Could Signal Skilled Nursing Upheaval



BY&S welcomes Danielle Andre and Ryan Carr as Healthcare Consultants. Danielle comes to BY&S with three and a half years of field exam experience in a variety of industries. She also has previous experience working in operations for a healthcare company. Ryan comes to BY&S with four and a half years of field exam experience in a variety of industries. Both Danielle and Ryan are excited about expanding their healthcare industry knowledge and BY&S is excited to have them join our team.


Drastic cuts are being made in Medicare spending resulting from a freeze in the Medicare market basket rate. With $1.9 billion cut, skilled nursing providers are expecting to struggle over the next decade. For more information read the article linked below.

Skilled Nursing Operators Face Down ‘Unsustainable’ $2 Billion Cut



The Senate just confirmed the second Department of Health and Human Services secretary in the Trump administration, Alex Azar. For more information about Azar and the Senate vote read the article below.

Azar, Open to Medicaid Caps, Confirmed as HHS Secretary


There has often been differing opinions whether a company that uses a Professional Employer Organization (PEO) for its payroll and benefits is ultimately liable for payroll taxes if the PEO does not remit the taxes. Read the article below for information related to this matter.

Professional Employer Organizations (PEOs) & Taxes: Don’t Assume Anything


In relation to the article posted on January 9, five nursing home providers are suing the state of Illinois. The providers are accusing the state of breaking federal laws related to Medicaid and claim that this will hurt their businesses possibly to the point of being forced to close. Read more in the article linked below for details on the current Medicaid predicament.

Skilled Nursing Providers Sue Illinois Over Medicaid Rates


Desires to modernize the hospital assessment program in Illinois have hospitals worrying about their budgets. Hospital executives say the result would be multiple hospitals shutting down due to the vast majority relying on the money they get back from the hospital assessment program as it currently stands. It seems that some hospitals will benefit, but many will suffer. For more details read the article below.



Corporate webs behind nursing homes are leading to worse care for residents and monetary benefits for owners. Not only is money being funneled out of these nursing homes and ending up in the pockets of the owners, but when it comes to taking legal action for poor care the owners have an advantage. Find out more in the article below.

Care Suffers As More Nursing Homes Feed Money Into Corporate Webs


With a new tax reform in place, the effects on skilled nursing operators and investors are unclear. The tax bill has advantages and disadvantages that make it difficult to classify as a win or a loss for the healthcare industry. Read more in the article below for more information:



BY&S just wrapped up its 2017 company retreat in Austin, Texas. Between having employees located all across the country and hiring new people this year, the retreat was a perfect opportunity for everyone to meet and get to know each other. The group events of the weekend came to a close with a spirited axe throwing competition resulting in a win for Luke Dempsey from our corporate office. Everyone had a great time and we are all eagerly awaiting next year.


Becoming a manager means a whole new set of responsibilities along with the difficult task of learning how to work with different personalities all while attempting to keep a team as productive as possible. Whether attempting to direct an employee promoted to a management position or looking for new tactics yourself, the article below is full of key tips on how to be a successful manager.



The Department of Justice is cracking down on healthcare fraud but new standards set by ASC 606 adds complexity and could lead to unintentional accounting errors, material misstatements and fraud . Find out more in the article below.



The article linked below does a good job of comparing healthcare systems of different countries such as Canada, Britain, Singapore, Germany, Switzerland, France, Australia, and the U.S.



Iowa and Oklahoma are both struggling to find insurers selling Affordable Care Act-complaint plans. In an effort to fix this they have submitted waiver requests to CMS. Find out more in the article below.


Section 1115 of the Social Security Act has allowed states more flexibility when it comes to the Affordable Care Act’s Medicaid expansion in the form of waivers. Seven states so far have been approved or applied for Section 1115 waivers. Get more details in the article linked below.


Three final rules outlining 2018 Medicare payment rates have been issued. These rates are for skilled nursing facilities, hospice, and inpatient rehabilitation facilities. For details of these new rules and rates, read more in the article below.



CMS issued a final rule regarding 2018 Medicare payment rates and quality programs for skilled nursing facilities (SNFs). Payments to SNFs are projected to increase by approximately 1.0 percent compared to that of 2017. For more on this and details about changes to quality programs, read more in the article below:


CMS proposed a rule for home health agencies (HHAs) serving Medicare beneficiaries that would update 2018 payment rates and potentially redesign the payment system for 2019. CMS is redesigning the payment system to be more responsive to patient needs and to ultimately improve the overall patient outcome.  Find more details about these possible changes and a link to the proposed rule in the article below:



BY&S welcomes Keith Miu and Bryan Begane as Senior Healthcare Consultant and Healthcare Consultant, respectively. Keith comes to BY&S with over five years of field exam experience in a variety of industries. Bryan come to BY&S after one year as a junior field examiner. Both Keith and Bryan are looking forward to expanding their knowledge into the healthcare space and we are excited to have them join our team.