SNFs Report ‘Widespread’ Frustration with Medicare Advantage Plans, Study Finds

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.

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.”

SNFs being unwilling to take patients from certain plans could have significant implications, the study authors wrote, since patients could be adversely affected if SNFs push back on the MA plans. One possibility is that SNFs able to turn down MA patients are those of higher quality that can attract patients with other sources of coverage, the researchers said. They noted in the study that other research has found MA patients get care in lower-quality SNFs.

There also seems to be a disconnect regarding one of the most common refrains that surrounds Medicare Advantage: care coordination.

“Although MA plans were describing engaged approaches that perhaps included care managers in SNFs … SNF participants really didn’t seem to say much of that was actually happening,” she said. “And if it was [happening], it didn’t seem to impact the way care was provided in the SNF or the way the discharge planning in the SNF was happening. It didn’t seem to influence the length of stay in the SNF.”

But that said, many SNFs see results when engaging with MA plans, she said. For instance, one SNF found it useful to have a staff member dedicated to working with the plans, and identified benefits even within the authorization framework, Gadbois said.

“It might be a good use of SNF time and SNF dollars to dedicate a person — or at least some time from a staff person — whose job it is to really engage with the MA plan,” she told SNN. “I don’t remember how many SNF participants expressed this, but they seemed to indicate that when they made efforts to work with MA plans, those were generally beneficial — whether it’s plans being more wiling to accept appeals for length of stay, or just having someone at the MA plan to answer questions.”

Written by Maggie Flynn

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