TL;DR
Get workout gear delivered free with Prime
- Fast, free delivery on millions of items
- Prime Video, Amazon Music and more included
- Member-only deals all year
Leaders from three nursing home operators said at Skilled Nursing News’ RETHINK conference that they sometimes end Medicare Advantage contracts when payments do not cover care costs. They described using cost and outcome data in negotiations, educating residents about coverage choices and urging policy changes; the discussion did not establish how widespread these practices are.
Executives from three nursing home providers said they have ended or may end contracts with Medicare Advantage plans when payment rates fail to cover care costs, describing a negotiation strategy that can disrupt relationships but, they said, may be preferable to accepting inadequate reimbursement. The remarks came at the opening session of Skilled Nursing News’ RETHINK conference in Philadelphia this week.
Saber Healthcare Group President and founder Bill Weisberg said the company has dropped five to seven contracts in the past 24 months, including one about two weeks before the conference, because the plans did not cover the cost of care. He said promised increases in referrals may not make up for low rates because plans cannot determine where patients are ultimately discharged.
Weisberg said Saber reviews cost of care, length of stay, hospital readmissions and outcomes when negotiating. In some cases, he said, the company has used comparative data to argue for an additional $25 to $35 per day and secured a higher rate. He described the approach as being willing to leave a contract while leaving room for a plan to return to negotiations.
Creative Solutions in Healthcare CEO Gary Blake said his company also walks away from contracts and discusses insurance options with residents and their families. He said supplemental benefits such as grocery cards can attract beneficiaries’ attention, while residents may need help weighing those perks against coverage and care needs. Majestic Care CEO Paul Pruitt criticized the economics providers face, saying promised gains from meeting quality and cost measures often do not materialize.
Contract Disputes Reach Patient Care
The executives’ accounts show how payment negotiations can affect which plans nursing homes accept and the choices residents and families face. Leaving a contract can put pressure on an operator to replace residents covered by that plan, while potentially requiring beneficiaries to consider other insurance options. Blake said his organization explains alternatives, including other Medicare Advantage plans or traditional Medicare.
The discussion also connected reimbursement disputes with clinical decisions and staffing priorities. Blake and Pruitt said plan rules and payment pressures can create tension when clinicians believe a resident is not ready to leave a facility. The conference remarks describe providers’ concerns; they do not quantify how often these situations occur or establish the effect on patient outcomes.
Products Worth Considering
Levoit Vital 100S-P Air Purifier for Home and Pets
Therabody Theragun Relief Massage Gun, 3 Speeds, Navy
Garmin Forerunner 70 GPS Running Smartwatch, 43 mm, Black
As an affiliate, we earn on qualifying purchases.
Providers’ Negotiation Strategies
Medicare Advantage is a privately administered alternative to traditional Medicare. The executives discussed the plans in the context of nursing home operators being asked to meet quality and cost measures in return for better economics or referrals. Pruitt said those expected benefits often fail to appear, while acknowledging that managed care was intended to control health care costs.
The operators described two related responses: use operating and outcome data to seek higher rates, and leave contracts they consider financially unsustainable. They also raised advocacy in Washington as a way to seek broader changes. Creative Solutions, Blake said, is in ongoing discussions with lawmakers.
““We will walk away from those contracts, but we also go into them when we negotiate.””
— Bill Weisberg, Saber Healthcare Group president and founder
Scale and Effects Remain Unclear
The conference account does not identify the Medicare Advantage plans involved in Saber’s contract terminations or detail the terms of those agreements. It also does not provide independently verified data on how many providers are leaving contracts, whether referral promises commonly go unmet, or how often plans return with higher rates.
The executives’ comments represent their organizations’ experiences and views. The material does not include responses from Medicare Advantage plans, insurers, lawmakers or residents, nor data establishing how contract changes affect access to care, costs or outcomes across the sector.
Advocacy and Rate Talks Continue
Blake said Creative Solutions is continuing discussions with lawmakers in Washington, and the executives called for changes to policies they say put financial demands in tension with clinical judgment. The source does not specify a legislative proposal, timetable or upcoming decision.
At the provider level, the executives indicated they will continue using negotiations, operational data and contract decisions to press for rates they consider adequate. Whether plans will change their offers, and how residents will be affected when an operator leaves a contract, remains to be seen.
Key Questions
What did the nursing home executives discuss?
Leaders from Saber Healthcare Group, Creative Solutions in Healthcare and Majestic Care discussed payment negotiations and operational challenges involving Medicare Advantage plans at the RETHINK conference.
Why has Saber ended some Medicare Advantage contracts?
Bill Weisberg said Saber ended five to seven contracts over 24 months because the rates did not cover the cost of care. He said one contract ended about two weeks before the conference.
How does Saber negotiate higher rates?
Weisberg said Saber uses data on care costs, length of stay, readmissions and outcomes to make its case. He said that in some negotiations the company sought an additional $25 to $35 per day and received a higher rate.
What does Creative Solutions tell residents when it leaves a plan?
Gary Blake said the company educates residents and families about insurance choices, including other Medicare Advantage plans and traditional Medicare. The conference account does not describe individual residents’ circumstances or coverage decisions.
What remains unknown about the contract disputes?
The source does not identify the plans involved, show how common contract terminations are across the sector, or provide independent evidence about effects on access, costs or patient outcomes.
Source: rss
