Payment from Medicare Advantage (MA) plans has long been a thorn in the side for nursing homes, but some organizations are beginning to see improvements – although rates still fall far short of covering the cost of quality care.

“There’s not a big margin to be able to deliver care at 60% of what Medicare is paying,” Stuart Lindeman, CEO and president of Mission Health, told Skilled Nursing News, who has noticed a slight improvement in MA rates for his organization. “I still worry about the rates. I also worry about the quality. Do [MA plans] have the patient’s best interests in mind? I don’t believe so … Medicare Advantage is great when you’re healthy.”

And while optimal rates elude the sector, the industry’s advocacy has nudged MA plans to improve reimbursement, he said.

Halfway into 2025, besides MA payment rate hikes, Lindeman noted several other encouraging trends for the sector.

Lindeman, who sat down with SNN on the sidelines of the LTC 100 conference in May, was struck by the surge in technology solutions being offered, particularly AI tools that can reduce administrative burdens and keep nurses focused on bedside care.

And staffing, while better, remains an urgent area of focus for the Florida-based Mission Health, ​​Lindeman said. Mission Health has implemented flexible scheduling, daily pay, and meaningful benefits tailored to frontline workers.

Overall, attracting nurses to skilled nursing, as many gravitate toward more glamorous hospital specialties, remains a challenge, he said.

However, there are selling points nursing homes can use to draw workers, Lindeman said.

“Working in a skilled nursing facility gives [nurses] an ability to manage. And, the career growth is very strong in a skilled nursing community versus just a hospital,” he said.

The following interview has been edited for length and clarity.

SNN: What are Mission Health’s big areas of focus for 2025?

Lindeman: We are continuing to build our workforce. We have a great workforce and mission, but really retaining and recruiting the right people that’s a big focus for us this year.

Staffing was an issue before COVID-19, and the issue just got amplified. We lost hundreds of 1000s of people out of the workforce, and now they’re coming back, and we have to make sure we take care of them when they come back.

We’ve instituted different retention programs, and we’ve been able to focus on daily pay, scheduling, allowing staff to have input. We’ve instituted more benefits that cater to our staff’s needs. Sometimes we think a benefit sounds really good from the corporate office, but unless it adds value to our staff, why do it?

SNN: How is the competition with hospitals playing into the problem of shortage of nurses at nursing homes?

Lindeman: When I talk to nursing students, the nurses don’t necessarily want to come work in skilled nursing. They want to work in pediatrics and neonatal, maybe surgical, because our area may not be as exciting to them at the beginning. So we have to do a better job of educating the nursing schools, nursing professors, all of those people, to get them to say, “Hey, post acute or geriatrics is a very important part of the nursing continuum.”

I have known [nurses] at the state regulatory agency who have told the students not to go into nursing homes. It’s very frustrating, and I think we have to do a better job as a profession to attract those nurses to our business.

On wages, hospitals pay more because they can, but the differential is nowhere near what it was at one time.

SNN: Is there anything that has surprised you at the LTC 100 conference?

Lindeman: Probably more technology. I’m seeing many more technology-based companies talking to me about things that they can do, use of AI tools that they say will add value … We’re seeing a lot more this year.

SNN: Did you discover any useful technology-based solutions, and how can these help nursing homes in the future?

Lindeman: There are some great suppliers of technology present here that can help us be successful. There’s some strong competition among suppliers, and over the last couple years that has made them better.

I really believe in working with technology companies to help guide them in what we’re looking for. The best technology companies sit down and they talk to you and they say, “Here’s what we have. What do you need? What are your pain points?” And those technology companies are the ones that are going to be successful.

SNN: Besides staffing solutions, what kinds of technology are helpful for nursing homes?

Lindeman: Staffing and risk management are the big ones. If tech solutions can help your staff provide better services to your patients, that’s the kind I want in Mission Health. And we have some great partners.

I plan to follow up with some companies who focus on the quality of patient life, such as AI tools that are related to predictive analytics and giving more time to the nurse to be on the bedside.

We have to be able to allow nurses to do what they do best. Sitting behind a chart or sitting behind a desk or sitting on a screen is not what a nurse should be doing. It always frustrates me when I hear that [Minimum Data Set paperwork] is being done from the central location somewhere, not actually being done at the bedside. I want our nurses at the bedside. I want our nurses taking care of the patients. So if there are tools available to help them do that, then I am all for it – anything to simplify things.

SNN: How are Medicaid Advantage rates for Mission Health, and what challenges are you confronting from MA?

Lindeman: I’m seeing MA rates go up a little bit. And that’s because of the pressure that they are under. There’s not a big margin to be able to deliver it at 60% of what Medicare is paying. It’s just not possible. So I think that they’re recognizing, if they want to keep their clients, they’re going to have to pay the providers a fair amount.

But I still worry about the rates. I also worry about the quality. Do they have the patient’s best interests in mind? I don’t believe so. Somebody said today – which I thought was on the mark – that Medicare Advantage is great when you’re healthy. I can think of patients that we tried to discharge home that have Medicare Advantage, and they can’t get proper home care. And that’s a problem. [MA plans] have got to get better at that. But the associations have done a great job, the industry has done a great job in getting that word out. And I think legislators are now saying, “Wait a second, we got to fix this.”