With Medicare Advantage revenue “significantly lower” than fee-for-service reimbursement, a new Zimmet Healthcare Services Group analysis says, skilled nursing facilities need to weather today’s “reimbursement storm” in order to make it to the incoming wave of baby boomers that will need facility services.
In the meantime, Zimmet suggests operators utilize facility data to improve MA performance.
“Most MA claims were submitted by SNFs with at least a three-star rating, but in areas with less bed-saturation, two-stars were not uncommon,” the report said. “There was no correlation between 5-Star rating and episodic revenue, while the 30-day hospital readmission rate explained less than 20% of payment variation.”
SNFs with the best outcomes and low costs can market their “value proposition” to MA plans using comparative data, county-level metrics offered via Zimmet’s CORE Analytics via its Medicare Advantage Post-Acute eXchange (MAPAX).
MAPAX, which launched in April, benchmarks MA performance based on “local peer group,” taking into account market-based revenue and value metrics.
“Providers know very little about their Medicare Advantage performance, more specifically market capture levels and then revenue and outcomes in a specific market,” said Vincent Fedele, partner and director of analytics at Zimmet. “We’re trying to neutralize and level the playing field in that regard, and publish the information on the Medicare granting side, based on our own proprietary data set for the claims that come in.”
Operators could then compare their revenue performance and outcomes to other facilities of an equal size and market.
“There’s a lot of data available for Medicare fee for service (FFS). There are companies that sell that data for a lot of money — there’s virtually none on Medicare Advantage,” added Marc Zimmet, CEO of the consulting firm. “When nursing homes are negotiating, or dealing with Medicare Advantage plans, and the rates are very low, the nursing homes could call the Medicare Advantage plan and try to get a rate increase … we have these measures to really quantify facility performance.”
CORE is the consulting firm’s software data company; analysts get relevant data directly from SNF claims submitted to the company. Fedele said the Centers for Medicare & Medicaid Services (CMS), nor any other governing body, publishes this type of data.
“We joke around that insurance companies are going to hate this product because it sheds light on this black hole of data so well,” said Zimmet. “The insurance plans have all the information but they don’t share it.”
CORE has received submissions from more than 3,000 skilled nursing facilities across 49 states since its formation in October 2019 — these submissions make up more than 30% of all SNF Medicare Part A claims on a national level.
For MAPAX, 1,000 of these providers have uploaded MA SNF claims from March 1 to Aug. 31 of this year. Zimmet hopes to have most of CORE’s 3,000 users engaged and contributing to its featured MAPAX product by early next year.
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