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Medicare Advantage Proves To Be the ‘Most Profound’ Disruptor for Nursing Homes, Reshaping Payer Dynamics
Of the many significant factors affecting the skilled nursing industry in the last five years, Medicare Advantage was named as a major disruptor, as cost
skillednursingnews.com
Major payer, major burden
From an episodic perspective MA in many states is becoming the major payer, Taylor said. However, this is also creating a huge administrative burden for nursing home operators, as well as complicating the understanding of the dynamics behind referral sources and the management of episodic patients.MA reimburses on average 20% to 30% less than traditional Fee-for-Service Medicare. And while there may be occupancy gains with MA enrollees, there isn’t the same amount of financial benefit, Taylor said.
“A shift from Medicare to managed care erodes average revenue per patient day, but the staffing levels required to deliver that care plan remains the same. It just means trimmed margin,” said Wilson.
