Editor’s Take: Skilled Nursing Industry Can Ignore Medicare Advantage at its Own Risk

Every industry gathering has a theme, whether it’s an intentional move by the organizers or not. But the most illustrative conference experiences come when attendees and those in charge both can’t stop talking about the same subject — as was the case this past week at the National Investment Center for Seniors Housing & Care’s (NIC) annual spring conference in San Diego.

Medicare Advantage was the topic of the moment in Southern California, with panelists and rank-and-file attendees going out of their way to talk about the ways providers can adapt to the rise of managed plans nationwide. There was a stark divide in tone, however, between the people on stage preaching MA necessity, and the folks in the crowd expressing surprise at how often the issue came up.

This article won’t provide any tips on how to work with UnitedHealthcare, Aetna, or other insurance giants — though there’s no shortage of that information elsewhere on our site. Instead, I’m writing to ensure that all of our readers, from the C-suite executives to the building administrators and frontline caregivers, have Medicare Advantage at the forefront of their plans moving forward — or risk serious peril.


Whether industry likes it or not

Former Speaker of the House Paul Ryan set the tone early during NIC’s event last week, boldly predicting that managed plans will be the future of the Medicare program writ large. That assessment, of course, aligns with the now-retired Republican’s longstanding agenda of reducing the size of government and turning to private partnerships to solve certain big-picture problems.

The conference continued on with looks at how Institutional Special Needs Plans (I-SNPs) can help providers weather the issues that Medicare Advantage plans bring, including lower daily reimbursements than traditional Medicare and an increased pressure on shortening lengths of stay. While the plans aren’t for everyone, requiring scale and a solid long-term care census, the operators that have pulled off the programs report greater control over their reimbursements and fewer headaches.

As a publication, SNN takes no stand on the political wisdom behind Ryan’s comments or the overall push for Medicare Advantage, but at this point the issue is almost out of both providers’ and lawmakers’ hands. Medicare Advantage penetration currently sits at 34% of all eligible enrollees, according to an analysis from the Kaiser Family Foundation released last fall, a figure that had nearly doubled from 2008. The non-partisan Congressional Budget Office predicts that number will rise to 42% by 2028 — a proportion that four states have already surpassed, with Minnesota leading the way at 56%, according to KFF.


For consumers, the Medicare Advantage choice is clear, filling in gaps in their traditional Medicare coverage and helping to defray out-of-pocket costs as they enter their fixed-income years. So even if you happen to be reading this from a state like Vermont or Wyoming, the trend line is moving upward, and over the course of the next decade, your organization will have to deal with a greater proportion of Medicare Advantage residents.

Heads in the sand?

Still, the wall-to-wall Medicare Advantage coverage at NIC seemed to come as a surprise to many folks listening to the panel discussions, as it has at other conferences I’ve attended in my time on this beat. And I think I know the problem: Unlike other settings in the senior housing and care space, Medicare Advantage represents an existential threat to SNFs, not an area of opportunity, making it just one more headache in a sea of other problems that may seem more pressing in the moment.

With acute care hospitals and insurance plans calling the shots in new value-based systems like accountable care organizations (ACOs) and bundled payments, SNFs are forced to take what they can get downstream, and focus on day-to-day survival under traditional fee-for-service Medicare and Medicaid.

During our regular chats and meetings, the editors of our sister sites Senior Housing News and Home Health Care News tell me that any story about Medicare Advantage will generate a solid traffic day. That’s because the Centers for Medicare & Medicaid Services (CMS) has moved to expand the types of services that Medicare Advantage can cover, from certain home health supports to adult day services — potential boons for those other industries, which rely far more on private-pay residents than skilled nursing operators and see MA as a new income stream.

A skilled nursing operator, meanwhile, sees the phrase “Medicare Advantage” and rightfully thinks first of the hundreds of dollars less per day that he or she receives for each resident with such a plan, or the intense pressure to discharge residents after only seven days.

Going forward, though, it’s clear that when operators and investors in the nursing care space see “Medicare Advantage,” they need to just think “Medicare.” Barring the victory of progressives in Congress who have launched a major push toward universal health care through “Medicare for All” — a tough political mountain to climb — the gulf between traditional Medicare and Medicare Advantage will continue to narrow, with SNFs’ survival contingent on adapting to this new normal.

So the next time you see a Medicare Advantage headline on this site, or anyone else’s for that matter, it might be wise to suppress the knee-jerk reaction and look for the opportunity — before it’s too late.

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