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Executives from three nursing home operators said at a Skilled Nursing News conference that they have walked away from some Medicare Advantage contracts when payments did not cover care costs. They also described using performance data to seek higher rates and urged policy changes, while details of the contract cuts and their effects on residents were not provided.
Executives from Saber Healthcare Group and Creative Solutions in Healthcare said they have walked away from some Medicare Advantage contracts when reimbursement did not cover the cost of caring for nursing home residents, renewing debate over how plans pay skilled nursing providers. At the opening session of Skilled Nursing News’ RETHINK conference in Philadelphia, leaders from Saber, Creative Solutions and Majestic Care described contract negotiations, referral expectations and policy concerns; the report did not identify the plans involved in the contract cuts.
Saber President and Founder Bill Weisberg said the company had ended between five and seven contracts over the previous 24 months, including one about two weeks before the conference. He said the contracts did not cover the cost of care. The report did not specify the affected facilities, insurers or number of residents covered by those agreements.
Weisberg said Saber tracks cost of care, length of stay, hospital readmissions and outcomes when negotiating. He described presenting comparative data to plans to argue that a higher daily rate could still support efficient care. In some cases, he said, plans returned to negotiations and agreed to add $25 to $35 per day. The report did not identify the plans or the number of contracts that received these increases.
Gary Blake, CEO of Creative Solutions, said his company also has walked away from contracts and talks with residents and families about their coverage options. Paul Pruitt, CEO of Majestic Care, criticized the gap between performance expectations and the financial results providers say they receive. The executives also discussed policy advocacy, including concerns that payment reductions or discharge pressure can conflict with clinicians’ assessments of patients’ readiness to leave a facility.
Contract Choices Shape Care Funding
Medicare Advantage arrangements affect how nursing homes are paid for care provided to residents enrolled in those plans. When a provider concludes that a contract’s payment does not cover its costs, ending the agreement can change which coverage options are available to residents at that facility. The conference report did not detail what happened to residents after the cited contract terminations, so their direct effects cannot be assessed from the information provided.
The executives’ accounts also point to a tension between financial terms and clinical decisions. Blake and Pruitt said plan payment or discharge pressures can arise soon after admission, while clinicians may judge that a patient needs more time. Those concerns were presented by the operators; the report did not include responses from insurers or independent data comparing plan practices.
How Operators Describe Negotiations
The executives said some Medicare Advantage plans offer nursing homes the prospect of additional referrals in exchange for accepting lower payment. Weisberg argued that such referrals are not guaranteed because plans do not control where discharge planners, patients or families choose to send someone after a hospital stay. He said Saber prefers to end agreements it considers inadequate and seek residents whose coverage pays more appropriately.
The speakers described two approaches alongside termination: using operating and outcome data to press for better rates, and explaining coverage choices to residents and families. Blake said families may consider other Medicare Advantage plans or traditional Medicare. He also argued that supplemental benefits, such as grocery cards, can draw attention away from questions about health care coverage. These were the executives’ assessments, not findings independently tested in the conference report.
““So it’s kind of like you’re playing a game of chicken.””
— Bill Weisberg, Saber Healthcare Group president and founder
Contract and Patient Effects Unreported
The report does not name the Medicare Advantage plans Saber ended contracts with, identify the facility locations or quantify how many residents were affected. It also does not say whether those residents changed plans, moved facilities or continued receiving care under other arrangements.
The reported rate increases of $25 to $35 per day were described by Weisberg, but the account gives no contract-level details, comparison rates or number of agreements involved. The conference remarks also do not establish how frequently payment cuts or discharge pressure occur across the industry, or how insurers would respond to the providers’ criticisms.
Advocacy and Plan Talks Continue
Creative Solutions is in ongoing discussions with lawmakers in Washington, Blake said. He and Pruitt called for policy changes to better support seniors and the organizations that care for them. The source report does not identify a specific bill, policy proposal, hearing or decision date.
At the provider level, the executives described continued negotiations with plans, including presenting cost and outcome data and ending agreements they consider inadequate. The timing and results of future talks were not reported. Whether additional contracts will be changed, and what that could mean for residents’ coverage and access to facilities, remains unknown.
Key Questions
Why did Saber end some Medicare Advantage contracts?
Weisberg said Saber ended five to seven contracts over 24 months because they did not cover the cost of care. The report did not name the plans or facilities.
How does Saber seek higher reimbursement?
Weisberg said Saber uses information on care costs, length of stay, readmissions and outcomes in negotiations. He said some plans agreed to rate increases of $25 to $35 per day after reviewing comparative data.
What coverage options did Creative Solutions discuss with families?
Blake said the company educates residents and families about Medicare Advantage choices and traditional Medicare. The report does not describe individual coverage decisions or their results.
What policy changes are the executives seeking?
Blake and Pruitt called for changes to Medicare Advantage policies, citing concerns about payment reductions and discharge pressure. The report does not identify a specific legislative proposal.
Source: rss
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