Amid Medicare Advantage’s rise, future policy shifts – including faster prior authorization requirements and Medicaid cuts – could increase nursing homes’ challenges with uncompensated care and care transitions.

Experts say proactive planning and greater technology use can help facilities ease patient transfers and reduce costly hospital delays.

At a recent webinar moderated by Skilled Nursing News, these experts noted that Medicare Advantage is simply adding to the challenges of transitions between skilled nursing facilities (SNFs) and hospitals. But, perennial issues related to care transitions also stem from medication errors and incorrect level of care assigned to patients.

Michelle Stuercke, chief clinical officer at TCM Consulting and Management, who oversees developing and implementing specialty clinical programs at TCM managed properties, stressed the importance of accurate documentation to avoid medication errors, which can often result in costly health risks.

Meanwhile, Carrie Kneisley, director of health care admissions at Pennsylvania-based Garden Spot Communities, said the complexity of determining the best care level for residents, can also make transitions difficult.

“[I]n a continuing care community … you have to figure out what is the best level for them. Is it skilled care? Is it personal care? And then, getting all the teams together on what’s best for the resident,” she said. “So that’s kind of what I’m working through right now. So it’s definitely a problem that happens on a regular basis.”

However, AI tools are helping limit such mistakes and ease tasks amid improving interoperability, which is the exchange and integration of health records from different health care systems such as hospitals and SNFs. Technology is also reducing administrative burdens, and enhancing care coordination during transfers, the panelists said.

Medicare Advantage’s costly role and tech help

A recent study found that compared to traditional Medicare fee-for-service patients, Medicare Advantage patients are 3.1% more likely to have hospital stays over 14 days before transferring to a nursing home, causing hospitals $5.5 billion in 2023 discharge delays due to prior authorization and network issues.

To prevent delays at TCM, Stuercke said her organization’s facilities start prior authorizations immediately when a patient is expected, reducing hospital stays of several unnecessary days.

“If we have to redo it, if it expires before the patient comes, that’s fine, but at least if we can start it right away, there is less chance that there will be a hold up at the end,” Stuercke said.

Part of the problem with Medicare Advantage plans is that they are currently allowed too long of a window of time to make preauthorization decisions. According to the final rule, starting Jan. 1, 2027, payers must make decisions within 72 hours, or seven days for regular authorizations on the commercial side, and the current administration is trying to shorten it, said Bevey Miner, EVP of health care strategy and policy at Consensus.

But other administrative burdens could rise for facilities from federal policy changes, she said.

Given the focus on preventing waste and unnecessary treatments, policy decisions could introduce programs related to Medicaid, for instance, that closely review certain ICD-10 diagnosis codes, Miner said.

“There are a lot of things to watch on the policy side, a lot of uncompensated care that a lot of the care settings are just going to have to pick up because of the cutbacks in Medicaid,” said Miner. “And there’s going to be a much more stringent lens on Medicare Advantage and trying to fast track the prior authorizations for it.”

These policy changes could result in greater burdens for SNFs, given sizable patient data involved, for which technology can be really useful, Miner said.

The hospital-to-SNF transitions can involve a lot of documentation causing staff to sift through large files to find key information.

“If you have a 100-page PDF document, somebody, some human, has to look at it…You have to be able to digest that information the right way.”

And interoperability itself is improving, and so technology and AI tools have really helped.

But even facilities using more old fashioned ways such as digital cloud faxing can utilize these tools with the help of companies like Consensus, Miner said.

“[We] can take that and translate it into FHIR and extract data,” she said, referring to Fast Healthcare Interoperability Resources, or FHIR. “So that’s one way that you can actually help. But I think there’s going to be a lot of interesting things happening in 2026.”

Medication reconciliation

Some major issues in care transitions that will likely linger – including transfers to not just to the hospital but home – can stem from “medication reconciliation,” involving dangerous situations of drug interactions. Often, this is because patients are being prescribed multiple medicines from different providers.

Stuercke recalled instances where the patient was placed at high risk due to this practice. 

“Luckily, our pharmacist caught it, but you always have to think, ‘what if this resident would have gone home and taken those two meds together?’”

In the end, careful transitions come down to complex planning.

“The biggest issue is that it’s not just a simple thing. It’s not a ‘yes’ or a ‘no.’ It’s more like, how can we meet their needs and what’s best for the resident? And it’s financial, it’s medical, it’s mood, it’s cognitive,” Kneisley said.