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Changes to nursing home enforcement on the federal level have been increasing over the last few years and it appears these changes are only going to continue. Since nursing homes are a unique type of facility where the people are both patients and residents, improvements, particularly related to care and safety, are in desperate need. For more information read the article linked below.

CMS Chief Medical Officer: More Changes Coming to Nursing Home Compare, Quality Measures



As part of the Cures Act, workers and staff providing personal care and home health services to patients will be required to use Electronic Visit Verification (EVV) for their time. In other words, care workers will need to clock in and out electronically by shift in real time. This is a huge change for those not currently requiring employees to clock in and out of shifts.

The act is designed to prevent fraud and enforce honesty when recording time and services. A provider’s reimbursement can even be reduced for non-compliance. Electronic Visit Verification (EVV) is effective 01/01/20 for personal care services and 01/01/21 for home health care services. For more information check out the resource linked below.


The new Patient-Driven Payment Model (PDPM) incentivizes the accurate diagnosis and treatment of depression by providing significant rewards for skilled nursing operators that treat residents’ specific needs. Skilled nursing providers had not been proactive about identifying depression in residents in the past, but now that depression is a reimbursement-sensitive condition providers can receive a payment boost of roughly $43 per day for treating depression. For more details read the article linked below.

Treating Depression Could Emerge as a PDPM ‘Linchpin’ — Both for Payments and Better Outcomes


From Top Left to Bottom Right: Michael Connor, Creighton Howard, Robert Stott, and Daniel Brinegar


We are excited to introduce four new employees to the BY&S team. Michael Connor, Daniel Brinegar and Creighton Howard join our office in Matthews, North Carolina, and Robert Stott joins our corporate office in Forest Hill, Maryland.

Mike is a recent graduate of Wilkes University in Wilkes-Barre, PA where he earned his MBA in May 2019 after graduating from Wingate University in Wingate, NC. Daniel is a graduate of Appalachian State University where he earned a BS and BBA in Finance and Commercial Bank Management. Since graduating, Daniel has spent the last couple of years working in the banking environment.  Creighton is a recent graduate of Emory & Henry College where he majored in accounting and minored in economics. Rob graduated from Towson University where he received a BS in Business Administration with a concentration in Finance. For the past several years Rob has worked as a budget analyst at Johns Hopkins School of Medicine.

Mike, Daniel, Creighton, and Rob all join our team of healthcare financial consultants working on field examinations in various healthcare industries, and Rob will also work with our healthcare monitoring group. We are happy to welcome them all to our BY&S family!


Federal healthcare policymakers are proposing a new payment rule for 2020 that would begin to phase out pre-payments for home health services and replace them with a new notice of admission requirement for home health agencies that comes with built-in penalties. As a result, home health providers are concerned about the proposed structure. For more details read the article linked below.

CMS Finding New Ways to Penalize Home Health Providers


Senior Living operators are becoming more and more willing to enter into RIDEA structures with real estate investment trusts (REITs). This increase in comfort is due in part to persistent pressures due to labor and operational expenses. For more information read the article linked below.

Senior Living Heeds Lessons from a Decade of RIDEA




The new Patient-Driven Payment Model (PDPM) is leaving skilled nursing providers confused with how to assess the reimbursement for Medicaid patients. Though this new payment model has been viewed positively at times, state Medicaid programs are starting to notice the challenges and difficult transition headed their way. To find out more, read the article linked below.

Despite Relief, PDPM Could Create Medicaid Headaches for Skilled Nursing Operators


A new study from the Kaiser Family Foundation questions whether Medicare Advantage actually saves the government money. The study found that that the money saved could have more to do with the people who use Medicare Advantage than the program itself. For more information read the article linked below.

Medicare Advantage Plans’ Strategies May Not Actually Reduce Health Spending



Skilled nursing providers are gearing up for the Patient-Driven Payment Model (PDPM) that goes into effect on October 1, but some teams are more prepared than others. Responses to a survey of 70 respondents who represent over 130 skilled nursing facility communities show that skilled nursing providers are about 69% confident in their interdisciplinary teams’ preparedness, but are only about 32% confident in their clinical teams’ preparedness. To find out more read the article linked below.

Only 32% of Skilled Nursing Providers Feel Clinically Ready for PDPM



Skilled nursing operators can take an active approach in controlling Medicaid reimbursement by reducing eligibility mistakes. These mistakes can lead to millions in losses and skilled nursing operators are realizing they have more control over successfully avoiding eligibility errors and oversights than they once thought.

Avoiding Million-Dollar Medicaid Eligibility Mistakes in Nursing Facilities



Embracing Medicare Advantage (MA) could mean increased profit for providers. MA allows private companies to collect federal dollars by offering benefit packages that serve as an alternative to Medicare. With the inclusion of dental and vision into these benefit packages, senior living providers are able to offer more benefits than Medicare. To find out more read the article linked below.

How Senior Living Providers Can Profit as Medicare Advantage Gains Momentum



BY&S is pleased to announce the promotions of Evan Watts to Manager and Brian Zimmermann to Senior II, effective January 1 of 2019.

Evan has been with BY&S since January 2015 and brings to BY&S the versatility of being able to manage staff and client relationships while maintaining his own project workload. Brian has been with BY&S since June 2016 and has progressed quickly due to his dedication, strong work ethic and innate desire to learn as much as possible as fast as possible. Both Evan and Brian regularly are assigned to the firm’s most challenging projects.

“Evan and Brian have both become integral parts of the BY&S team and their efforts and dedication have contributed greatly to our firm’s success,” said Brian Young, Partner and CEO of BY&S. “We are proud to announce their well-deserved promotions and look forward to them continuing to be a vital part of our future here at BY&S.”


The Patient-Driven Payment Model (PDPM) continues to cause big changes in the skilled nursing industry. This particular article discusses the possibility of PDPM changing the norm from too many rehabilitation hours to too few. With no incentive to provide a large volume of therapy hours, providers could move too far in the opposite direction. For more details read the article linked below.

PDPM Creates New Litigation Risk for Skilled Nursing, Rehab Providers


When the switch to the new Patient-Driven Payment Model (PDPM) was announced the response was overwhelmingly positive, but as time has continued these opinions have shifted. Now it is near an even split between those who think the change will have a positive effect on revenue and those who think the change will have a negative effect on revenue. For a deeper analysis and explanation read the article linked below.

Skilled Nursing Industry Split on Whether PDPM Will Boost or Cut Revenues


Breslin, Young & Slaughter, LLC (“BY&S”) is pleased to promote Evan Schaller to Partner and shareholder of the firm.

Evan joined the firm in 2010 as a Field Examiner and progressed to Manager, Director and now to Partner. He has led due diligence field exams, quality of earnings reviews, and workout assignments across numerous healthcare industries. Evan has also championed internal efforts by assisting with staff training, cultivating client relationships and implementing due diligence best practices. In his new role, Evan will oversee BY&S’ quality of earnings and real estate products while continuing to assist with staff development and the overall growth of the firm.

“Evan is an extremely talented professional who has been a part of the core team that has grown BY&S from a small firm of less that 5 professionals to over 30 professionals in the past 10 years,” said Brian Young, Partner and CEO of BY&S. “This promotion to Partner and shareholder of BY&S is a deserved recognition of his proven abilities, his hard work, and his contributions to the firm. We are excited to have Evan help guide BY&S’ growth in the years ahead.”



BY&S held its 2018 corporate retreat in New Orleans, Louisiana. With employees spread across the country, our annual retreat is the one time every year that we all get together. For the second year in a row, the company decided to visit the home town of one of its employees. This year it was Juan Duboué’s chance to play host. After a day of reflection and education, the weekend kicked off with a competitive night of bowling. Our retreat continued the next day with some team members taking airboat tours through the Louisiana bayou, and others taking a bus tour through the heart of the city. Our staff enjoyed beignets from Café Du Monde and hurricanes from Bourbon Street. All in all, our trip to the Crescent City was a great team building experience.



The Centers for Medicare & Medicaid Services (CMS) is beginning to use payroll-based journal data to identify nursing homes with a significant decline in staff on the weekends. This information is being provided to state survey agencies with a goal of cracking down on insufficient nurse staffing levels especially on weekends. For more details read the article linked below.

CMS Implements Stricter Nursing Home Staffing Survey Rules for States


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.


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.