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Skilled nursing facilities voice displeasure with Medicare Advantage plans

December 6, 2018
by I Advance Senior Care
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Medicare Advantage (MA) plans are trying to reduce post-acute care spending by limiting the skilled nursing facilities in their networks, and by capping the lengths of stay — and SNFs and hospitals aren’t taking it well, according to Skilled Nursing News.

That’s according to a study published Monday in the American Journal of Managed Care, which tracked the opinions administrative and clinical staff working in 10 Medicare Advantage plans, 16 hospitals, and 25 SNFs about MA plans’ work to control costs, including post-acute spending.

The study authors conducted 154 interviews with the stakeholders, who hailed from eight markets across the U.S.

To reduce post-acute costs, MA plans said they try to direct patients to specific SNFs and to limit the length of time the patients stay at those SNFs. They did not, however, report trying to influence the initial post-hospital discharge setting, and neither SNF nor hospital participants reported MA plans trying to influence the type of post-acute setting.

MA plans most commonly authorized and capped the number of days they would pay for patients to receive SNF care, and SNFs had to then ensure the caps were not exceeded, the study found.

“SNF responses to the MA plans’ largely authorization-based LOS system were frequently negative, with adverse consequences related to LOS reduction including unwillingness of SNFs to take on patients from specific plans that were perceived to be too authoritative and whose practices were deemed too burdensome,” the authors wrote.

But that unwillingness did not appear to have resulted in SNFs outright refusing patients on certain MA plans, study author Emily Gadbois of Brown University told Skilled Nursing News — at least, not yet.

“The frustration seemed widespread, at least within our sample, but the SNFs that were actually refusing to work with the MA plans was very limited,” she said. “I think they were talking about it and thinking about it, and how it might impact the census they’re able to maintain and potentially, how much money they’re able to bring in [with] potentially choosing not to work with a plan.”

Read the full story at Skilled Nursing News.

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Comments

Well, issues like this should be taken with urgency before it can cause a commotion to the state.
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