CMS moved on Tuesday to expand its ACCESS Model with new payment tracks for heart failure and
COPD, extending remote monitoring and connected-device reimbursement to two conditions that
dominate the post-acute census. On the same days, a study of 914 nursing homes in Hurricane
Ian's path found that for-profit operators entered the storm already short-staffed and never
closed the gap — a finding that Rehinged data shows is not a Florida problem but a national
structural one, and one that is wider outside Ian's path than inside it.
Why it matters for vendors: These two stories describe the same commercial
opening from opposite ends. CMS is now paying for technology that watches patients between
visits, and 3,034 facilities carry a concentrated heart-failure and COPD population that makes
them the natural downstream partner for it. Crossing the two questions directly, Rehinged finds
that 84.4% of those dual-burden facilities are for-profit, against 76.5% of
everything else — and for-profit facilities nationally run 16% fewer total nurse hours per
resident per day than non-profits and 35% fewer RN hours. Any product that promises better
outcomes without more labor has a clearer path this quarter than one that assumes staff will be
there to run it.
Regulatory
Technology
Reimbursement
CMS Adds Heart Failure and COPD Tracks to ACCESS — Putting Reimbursement Behind Remote Monitoring for Two Conditions Concentrated in a Quarter of the SNF Market
What happened
CMS announced Tuesday that it will expand the Advancing Chronic Care with Effective, Scalable
Solutions (ACCESS) Model with new condition tracks covering heart failure, chronic obstructive
pulmonary disease, substance use disorders, tobacco cessation and chronic musculoskeletal pain.
The expansion begins in spring 2027. ACCESS launched in July 2026 with tracks for high blood
pressure, diabetes, chronic musculoskeletal pain and depression, and today has 160 participating
organizations; CMS says roughly three in four Medicare beneficiaries qualify for at least one
track. The model pays for virtual care, health coaching, remote monitoring, connected devices
and wearables between office visits, and ties payment to measurable improvement in patient
health rather than to individual services rendered.
Why it matters
ACCESS is not a skilled nursing program, and no SNF should read this as a new revenue line.
What it does is establish a federal payment pathway for continuous monitoring of two conditions
that define a large share of the post-acute census — which changes the economics for anyone
selling remote patient monitoring, connected vitals, pulse oximetry, telehealth infrastructure
or cardiopulmonary care-management software into the sector. Until now, the SNF pitch for those
products has run through readmission avoidance and managed-care contract performance, both of
which are indirect. A CMS model that pays participating organizations for outcomes in heart
failure and COPD gives vendors a second, cleaner argument: the buildings that hold these
patients become the place where an ACCESS participant's performance is won or lost, and
partnership conversations follow the money.
Rehinged analysis of Medicare beneficiary condition data across the scored facility base
identifies 3,034 facilities where more than half of Medicare beneficiaries
carry a non-ischemic heart failure diagnosis and more than 40% carry COPD. That is
26% of the 11,663 facilities with usable condition data on both measures — roughly one
building in four. Taken separately, the exposure is wider still: 5,557 facilities
cross the heart-failure threshold and 5,118 cross the COPD threshold. These
are not edge cases; they are the operating reality of a quarter of the market.
3,034
facilities with dual HF + COPD concentration
26%
of facilities with condition data on both
2.88
average Medicare risk score (vs. 2.51 elsewhere)
Beneficiary acuity in dual-burden facilities vs. all others
All other facilities
2.51 risk score
Dual HF + COPD facilities
2.88 risk score
Dual-burden facilities by state — top 8
Crossing condition concentration against payment and payer mix reframes what kind of
opportunity this is. Dual-burden facilities carry a pulmonary case-mix share of 28.2%, a
46.3% dual-eligible beneficiary share against 43.7% elsewhere, and an average Medicare
payment of $13,022 per stay. Their average overall rating is 2.84 stars,
slightly below the 2.99 of the rest of the market — but only 66 of the 3,034 also score
above 70 on Rehinged's rehospitalization dimension. That combination matters: this is not a
distressed-facility segment that a vendor can sell to on fear of penalties. It is a
high-acuity, high-volume, Medicaid-adjacent segment where budgets are tight and the buying
case has to be built on labor substitution and demonstrable outcome improvement. Ownership
reinforces that read: 2,562 of the 3,034 dual-burden facilities — 84.4% — are
for-profit, against 76.5% of the rest of the base, and they run 3.74 total nurse
hours per resident per day against 3.83 elsewhere, with RN coverage at 0.61 hours against
0.68. The facilities holding the most heart-failure and COPD residents are the ones with the
least clinical bandwidth to add a monitoring workflow by hand. Vendors selling remote
cardiopulmonary monitoring should concentrate pre-2027 partnership outreach on Florida, Texas
and Ohio, which together hold 832 dual-burden facilities — 27% of the national cohort — and
should lead with total cost of monitoring per resident-day and staff-time displaced, not with
clinical feature depth.
Watch for: CMS has not published participation criteria for the new tracks or
said whether post-acute providers can participate directly rather than as downstream partners.
Track the ACCESS Model page at cms.gov/priorities/innovation for the spring 2027 track
specifications, and watch whether the 160 current participants expand their site-of-care
networks into skilled nursing before the start date.
Staffing
Quality & Ratings
A Hurricane Ian Study Says Disaster Staffing Is Really Everyday Staffing — and the National Gap Is Nearly Twice What the Storm Data Showed
What happened
A September study in the Journal of Applied Gerontology tracked 914 nursing homes in Hurricane
Ian's path beginning 72 hours before the storm's September 2022 landfall, measuring total
nursing hours per resident per day, licensed-nurse hours and permanent-staff hours. Of the 914
facilities, 665 — 72.8% — were for-profit, and 420 of those were chain-owned. For-profit
facilities entered the storm with total staffing intensity 9% below their not-for-profit
counterparts, and after landfall closed only 1% of that relative gap. The authors' conclusion
is the interesting part: because both ownership types raised staffing by similar proportions
during the emergency, the disparity in post-disaster resident risk is driven by baseline
staffing, not by disaster-specific behavior. Preparedness strategy, the authors write, should
"emphasize sustained improvements in everyday staffing practices, particularly within
for-profit facilities," and prioritize supports that help existing personnel maintain
continuity of care during emergencies.
Why it matters
That conclusion redraws the emergency-preparedness buying map. If baseline staffing is the
variable that determines storm outcomes, then the budget that matters is not the one-time
preparedness line — generators, supply caches, evacuation contracts — but the recurring
workforce line. Vendors selling scheduling and float-pool software, credential-portable agency
platforms, documentation tools that return hours to the floor, and continuity-of-care systems
that function when a building loses connectivity now have a peer-reviewed argument for why
those purchases are preparedness purchases. Conversely, preparedness vendors selling equipment
alone should expect harder questions from operators about whether the spend changes anything
when the building is short three CNAs on a normal Tuesday.
Rehinged ran the study's core comparison against the full national base and found the gap is
considerably wider outside Ian's path than inside it. Across the 14,288 facilities with both
ownership and reported staffing data, the 10,643 for-profit facilities
average 3.69 total nurse hours per resident per day against 4.40 at the
2,752 non-profits, with the remaining 893 government-owned facilities excluded from the
comparison to match the study's two-way design — a
16% deficit, nearly double the 9% the study observed in the storm corridor. The registered
nurse gap is sharper still: 0.61 RN hours per resident per day at for-profits versus 0.94 at
non-profits, a 35% shortfall in exactly the license class that makes clinical decisions when
a physician cannot reach the building.
16%
national for-profit total staffing deficit
2,919
for-profit facilities in nine hurricane-exposed states
47.2%
average for-profit nursing turnover (41.2% non-profit)
Total nurse hours per resident per day, national average by ownership
For-profit (10,643 facilities)
3.69 HPRD
Non-profit (2,752 facilities)
4.40 HPRD
For-profit facilities in hurricane-exposed states — Gulf and South Atlantic
Across those nine Gulf and South Atlantic states, 2,919 of 3,813 facilities — 76.6% — operate
under for-profit ownership, closely tracking the 72.8% the study found in Ian's corridor, so
the ownership concentration is a regional constant rather than a storm-path artifact. The
state-level staffing gaps are widest where the study never looked: North Carolina for-profits
average 3.58 total nurse hours per resident per day against 4.96 at the state's non-profits,
Virginia 3.47 against 4.84, and South Carolina 3.62 against 4.81 — for-profit shortfalls of
25% to 28%, roughly double Florida's own 13% spread of 3.70 versus 4.24. Crossing staffing
need against turnover isolates
the sharpest segment: 285 for-profit facilities in these states combine
elevated Rehinged staffing-adequacy need with nursing turnover above 50%, and they average
1.86 stars, 65.6% annual turnover and 123 beds. These are large, low-rated,
high-churn buildings on the coast in the middle of hurricane season. Vendors selling
workforce continuity, scheduling and float-pool technology should build their fourth-quarter
territory plans around Texas and North Carolina first, and should frame the pitch as
preparedness rather than as HR software — because after this study, that is the framing
operators can defend to a board.
Watch for: Atlantic hurricane season runs through November 30, which means any
named storm making landfall in the Gulf or South Atlantic over the next ten weeks will be read
against this study. Watch also for whether state survey agencies in Florida, Texas and the
Carolinas begin citing baseline staffing in emergency-preparedness deficiencies, which would
convert an academic finding into a compliance exposure.