The FY 2027 SNF Proposed Rule may only be 40 pages long… but the implications for skilled nursing operators are massive.

In this episode of Gravity Healthcare Hacks, Melissa Brown breaks down the biggest takeaways from the proposed rule and explains what SNF leaders should be paying attention to right now — including reimbursement changes, PDPM case mix concerns, therapy adjustments, quality reporting updates, and why CMS is signaling increased scrutiny around MDS coding and documentation.

Melissa also walks through:

•  The proposed 2.4% reimbursement increase — and why many operators feel it falls short 
•  CMS concerns around “case mix creep” under PDPM 
•  Proposed payment reductions to Speech, Nursing, and NTA 
•  Why therapy components may actually increase 
•  What operators should be advocating for before the June 1, 2026 comment deadline 
•  How future all-payer MDS reporting could reshape quality visibility 
•  The growing importance of Medicare Advantage quality outcomes 
•  Why now is the time to audit your MDS processes and documentation 

If you operate a SNF, manage reimbursement, oversee MDS, or lead clinical operations, this is an episode you do not want to miss.

Read more and access additional insights from this episode here:
 https://gravityhealthcareconsulting.com/gravity-healthcare-hacks-podcast/fy-2027-snf-proposed-rule

Need help auditing your MDS processes, PDPM accuracy, or reimbursement strategy?
Visit Gravity Consulting or contact Melissa Brown and the Gravity team to learn how we help SNFs improve reimbursement accuracy, operational performance, and clinical outcomes.

Connect with Gravity Consulting:
 • Website: https://gravityconsulting.com
 • Contact Melissa Brown: https://gravityhealthcareconsulting.com/schedule-a-consultation
 • LinkedIn: https://www.linkedin.com/company/gravityhealthcareconsulting

Thanks for listening to Gravity Healthcare Hacks. Be sure to subscribe, leave a review, and share this episode with another healthcare leader navigating the changing SNF landscape.

Support the show

Contract rehab used to make sense.
Today… it’s quietly holding a lot of buildings back.

In this episode of Gravity Healthcare Hacks, Melissa Brown and Carly Chronister break down what’s actually changed—and why more organizations are moving to an in-house, hybrid therapy model.

This isn’t theory.
It’s what’s happening right now inside real communities.

You’ll hear:

•  Why PDPM and PDPM Medicaid changed the economics of therapy (for good) 
•  What contract therapy companies are no longer delivering—and why it matters 
•  How the hybrid model works (and what support actually looks like after startup) 
•  The real “gut check” numbers for therapy utilization in LTC, AL, and IL 
•  What happens to margins, outcomes, and staff morale when you make the switch 
•  What the transition process actually looks like (and why it’s easier than most expect) 

If you’ve ever wondered whether your therapy program could be doing more—for your residents and your building—this episode will give you a clear answer.

Because at the end of the day, this isn’t just about therapy.
It’s about control, visibility, and outcomes.

If this hits home for you, visit www.gravityconsulting.com and schedule a call. We’ll show you exactly what’s working, what’s not, and what to do next. 

Support the show

Is your rehab program truly performing — or just getting by?

In this episode of Gravity Healthcare Hacks, Melissa Brown and Lead Therapy Consultant Carly Chronister unpack what’s really happening inside today’s therapy departments — and why more leaders are requesting independent rehab audits than ever before.

With PDPM Medicaid reshaping financial realities and contract therapy models under pressure, many communities are starting to ask hard questions:

• Are we getting the clinical outcomes we should be?
• Is our therapy team properly supported?
• Are we leaving margins on the table?
• What risks might we not be seeing?

Melissa and Carly walk through what a comprehensive rehab audit actually reveals — from compliance gaps and operational blind spots to functional treatment opportunities and group therapy strategies that most buildings are underutilizing.

They also discuss:
 • Why therapist morale has declined in many contract models
 • The difference between “staffing a department” and strategically leading one
 • Common onboarding failures that set new therapists up to struggle
 • Why simply going in-house isn’t enough without the right oversight
 • How a hybrid management model can improve margins, outcomes, and retention

If your gut is telling you something isn’t quite right in rehab, this episode will help you understand what to look for — and what to do next.

Because in today’s environment, it’s not enough to assume therapy is working. You need to know.

Support the show

Why Everything Is Changing in Therapy — and You Should Too

Gravity Healthcare Hacks | Episode 64

The therapy landscape is shifting—again—and many senior living and skilled nursing operators are still relying on rehab strategies that no longer work.

In this episode of Gravity Healthcare Hacks, Melissa Brown is joined by Carly Chronister, Lead Consultant of Therapy Services at Gravity, to break down what’s really changing in therapy and why now is the time to reassess your approach.

They explore how the transition to PDPM fundamentally altered the role of therapy, why contract therapy models are struggling to deliver meaningful value in today’s reimbursement environment, and how PDPM Medicaid has further reshaped incentives—often in ways operators didn’t anticipate.

This conversation goes beyond theory and gets into what operators should actually be watching inside their buildings, including therapy minutes, outcomes, Section GG accuracy, nursing involvement, and where risk is quietly building under the surface.

If you’re questioning whether your current rehab strategy is still serving your residents—or your organization—this episode will help you understand what to look for, what’s changed, and what to rethink moving forward.

🎧 Subscribe to Gravity Healthcare Hacks for practical insights on operations, reimbursement, and strategy in senior living and post-acute care.

Support the show

As home health agencies prepare for 2026, CMS is turning up the heat on fraud, compliance, and enforcement—and the consequences are more serious than ever.

In this episode of Gravity Healthcare Hacks, host Melissa Brown, COO of Gravity Healthcare Consulting, is joined by Devin Kassi, VP of Home Health Operations, for a critical follow-up discussion on the Home Health Final Rule. This time, they dive deep into Medicare’s expanded authority around fraud investigations, retroactive payment recoupment, and why even unintentional missteps can put agencies at risk.

Melissa and Devin unpack:

• How CMS is redefining and enforcing fraud
• Why documentation errors can trigger massive repayment demands
• The growing importance of homebound status documentation
• How weak processes, outdated technology, and lack of education create dangerous blind spots
• What agencies must do now to protect themselves and remain viable

This conversation is a must-listen for home health leaders—especially smaller and single-location agencies—who want to understand what’s coming and how to adapt before it’s too late.

Because in today’s regulatory environment, doing nothing is the biggest risk of all.

Support the show

The 2026 Home Health Final Rule is late—but the impact is already here. In this episode, Melissa Brown (COO) sits down with Devin Kassi, Gravity’s VP of Home Health Operations, to break down what agencies should be doing right now to prepare for payment cuts, VBP changes, and rising operational demands.

Together they unpack:

• What a 3–6% payment reduction really means for agency sustainability
• Why your EMR might be costing you more than it’s saving you
• How AI-driven clean claims, documentation support, and automated intake can reduce labor needs and boost margins
• The organizational restructuring every agency should be evaluating before 2026
• How to prepare for the proposed Value-Based Purchasing changes—especially new OASIS measures for bathing and dressing
• Why recurring training, ongoing Oasis auditing, and external quality support are now essential
• Practical, actionable steps to future-proof your operations before the Final Rule arrives

This is Part 1 of a two-part conversation designed to give home health leaders a roadmap for navigating reimbursement cuts without compromising care or burning out their teams.

Because in today’s environment, survival isn't about what you know—it's about how fast you can adapt.

Support the show

As more states transition to PDPM for Medicaid, therapy is no longer the primary driver of case mix index (CMI). So where do providers turn next?

In this episode, Melissa Brown, COO of Gravity Healthcare Consulting, sits down with Dr. Rehan Shah, nephrologist and co-founder of CardioRenal Vision (CRV), to explore how cardiology, nephrology, and pulmonology services can transform PDPM Medicaid outcomes.

Together, they discuss:

• Why therapy-driven CMIs are declining under PDPM Medicaid
• How specialty physician programs improve documentation, acuity capture, and reimbursement accuracy
• The power of on-site care models—from dialysis to respiratory therapy—to reduce hospitalizations and boost CMI
• Practical steps for aligning physicians, MDS coordinators, and facility leadership

If your organization is preparing for PDPM Medicaid—or already navigating the transition—this episode offers actionable insights to help you strengthen performance, accuracy, and margins under the new model.

🎧 Hosted by: Melissa Brown, COO, Gravity Healthcare Consulting
📍 Guest: Dr. Rehan Shah, Co-Founder, CardioRenal Vision

Support the show

What happens when you bring together seniors and young adults with special needs under one roof? In this episode, Melissa Brown sits down with Chiriga Ofori, CEO of Kinbridge at Oviedo, to explore her groundbreaking intergenerational assisted living model.

Chiriga shares how her personal journey as a caregiver inspired her to reimagine senior living, blending wisdom, energy, and support across generations. From creating meaningful connections and combating isolation to making the greenhouse small-home model operationally sustainable, she reveals how Kinbridge is building true community.

If you’re a senior living operator, healthcare professional, or just curious about new approaches to person-centered care, you’ll walk away with insights, inspiration, and practical advice.

Support the show

In this second half of our deep dive, Melissa Brown, COO of Gravity Consulting, continues her conversation with Melissa Keiter on the critical challenges—and opportunities—of PDPM Medicaid.

This episode unpacks real-world strategies for facilities navigating the transition, from documentation pitfalls and audit risks to proactive coordination across nursing, MDS, therapy, and ancillary partners. You’ll hear insights on:

• Why supportive documentation is more important than ever
• How respiratory therapy, wound care, and psychological services can strengthen your PDPM scores
• The role of coordination between MDS, clinicians, and outside specialists
• Why a proactive, team-based mindset is essential to avoid leaving dollars—and care opportunities—on the table

Whether your state has already transitioned or is still under a rate freeze, this episode will help you prepare your staff, adjust your systems, and avoid the financial and operational risks of falling behind the curve.

Support the show

The clock is ticking. With the mandatory transition to PDPM Medicaid coming October 1st, many providers are still unprepared—and it’s already impacting their margins.

In this episode, Melissa Brown is joined by Melissa Keiter, MDS expert and Lead Consultant for Nursing Services at Gravity Consulting, to break down the real-world implications of this sweeping policy shift. From reimbursement cuts to team readiness, they explore why relying on therapy-driven documentation is no longer enough—and what nursing homes must do to avoid sinking under PDPM Medicaid.

You’ll learn:

• Why some facilities are already losing $5–$15 per patient per day
• How Section GG impacts your bottom line—and why nurse aides hold the key
• What to do if your state is including therapy in the Medicaid rate
• Tactical strategies for nursing-only states
• How to prepare your entire care team—from dietitians to social workers

This is part one of a two-part series. Don’t miss this critical conversation designed to help you protect your CMI and stay financially afloat during the transition.

Support the show