As census rebounds across nursing homes, the growing influence – and financial strain – of Medicare Advantage is pushing providers to rethink both their payer mix and physical design of buildings. While the industry is clearly moving toward Medicare Advantage and value-based care models – and making accommodations to balance quality care with reduced reimbursement […]
The number of Medicare Advantage Institutional Special Needs Plans (I-SNPs) is down 5% for plan year 2026, but the number of I-SNPs led by a provider organization is up. This was one finding from an ATI Advisory analysis of Medicare Advantage (MA) plan offerings, which were the topic of an Oct. 1 webinar. Despite the […]
The rise of Medicare Advantage has created problems related to skilled nursing, including “unneeded and unnecessary care delays,” according to Trilogy Health Services Chief Medical Officer Andrew McNamara, M.D. However, SNF providers also have to better understand Medicare Advantage in order to address these issues, McNamara told Skilled Nursing News in an interview that has […]
Aetna is scaling up a program to provide more support to Medicare Advantage beneficiaries who are transitioning from the hospital into skilled nursing facilities or to their homes. The Aetna Clinical Collaboration (ACC) program involves Aetna nurses who coordinate with hospital staff to provide more patient support during care transitions, with reduced hospital readmissions being […]
Hospital length of stay has been increasing more dramatically for Medicare Advantage beneficiaries than traditional Medicare beneficiaries, and this trend is especially pronounced for people who are discharged to a skilled nursing facility. This is according to an article recently published in JAMA Internal Medicine. In the third quarter of 2023, hospital patients on Medicare […]
By Sloane Airey As pressure mounts for the skilled nursing industry, Brickyard Healthcare is making progress on key goals, such as driving down annualized turnover. The company also is achieving lower rehospitalization rates while also moving forward — along with partner organizations — on the nation’s largest provider-owned Medicare Advantage Institutional Special Needs Plan (I-SNP). […]
The Trump administration’s approach to regulation is creating long-sought opportunities for nursing home providers to have more say in shaping policies, but providers must do a better job of promoting the areas in which they excel. Steve LaForte, CFO and principal at Cascadia Healthcare, describes the new administration’s approach as “rational regulation” – a way […]
By Kristin Carroll Medicare Advantage (MA) plans, which cover a majority of Medicare enrollees, are denying or delaying medically necessary post-acute care with alarming frequency. That’s according to a survey from the American Health Care Association (AHCA), the nation’s largest nursing home provider association. The survey went to 363 nursing home providers in May 2025. […]
The success of skilled nursing and long-term care providers today and in the future is increasingly tied to how swiftly and successfully they can adapt to a world in which complex care is rapidly migrating out of the hospital. “The health systems, hospitals – our acute care partners – are really looking to fine-tune what […]
Senators are pressing UnitedHealth Group (Nasdaq: UNH) over concerns that the company inappropriately encourages nursing homes to limit hospitalizations for residents enrolled in some of the company’s Medicare Advantage health plans. The probe was launched by Sens. Ron Wyden (D-Ore.) and Elizabeth Warren (D-Mass.) following a May report in The Guardian alleging that UnitedHealth is […]
Fee-for-service Medicare’s skilled nursing facility (SNF) utilization remained stable at 22.7%, unchanged in the fourth quarter of 2024 compared to the same period a year ago, as Medicare Advantage penetration continued to grow, according to the latest Trella Health 2025 Post-Acute Care Industry Trend Report, released Monday. Moreover, FFS nursing home utilization rates varied widely […]
Editor’s note: President Donald Trump signed the so-called One Big Beautiful Bill Act (OBBBA) into law Friday, a day after it was narrowly passed by Congress. The House passed the reconciliation bill on Thursday with the Senate-passed version largely intact. While the bill included some nursing home-friendly provisions – such as a 10-year delay on […]
Amid increasing evidence that prior authorization and denials in Medicare Advantage (MA) may delay access to nursing homes, a new study shows that MA patients often experience longer hospital stays before discharge to a post-acute care setting, compared to those with traditional Medicare. This is according to a June study by NORC at the University […]
More than 40 health insurance providers announced a joint initiative on Monday and met with Trump administration officials to overhaul and streamline the prior authorization process by reducing administrative burdens on health care providers. However, there remains a big question mark over whether the move will ease pain points for nursing homes. The insurers – […]
Ignite Medical Resorts is entering the second half of 2025 eager for regulatory reform, but it has been able to overcome burdens stemming from managed care so far by envisioning it as a “core competency” alongside a strong focus on tech innovation. The company is also forging ahead with plans to grow its physical footprint […]
While Centers for Medicare & Medicaid Services (CMS) has made improvements following previous recommendations from the Medicare Advisory Commission (MedPAC), the Medicare Advantage (MA) program and the value-based purchasing program still suffer from “design flaws,” according to the organization. MedPAC is calling attention to what it perceives as design flaws in the programs, including incentives […]
Allegations against UnitedHealth Group (NYSE: UNH) that it secretly paid nursing homes in order to reduce hospital transfers of residents under its Medicare Advantage (MA) plans are leading lawmakers on both sides of the aisle to increase calls for a federal investigation. Last week, UnitedHealth filed a defamation lawsuit against the Guardian newspaper – whose […]
Physiatry is becoming a cornerstone of skilled nursing care in the midst of a push toward value-based reimbursement in Medicare and Medicaid. Its integration into care teams has helped improve outcomes while reducing costly hospitalizations, industry leaders said. The rise of patient acuity has been a huge driver in the evolution of physiatry in nursing […]
Nursing home stakeholders remain cautiously optimistic regarding Medicare Advantage plan audits announced by the Centers for Medicare and Medicaid Services (CMS) last month, but many hope the agency will extend the same scrutiny to prior authorizations, AI usage and internal coverage criteria. Operators are unlikely to face reimbursement cuts as a result of the audits, […]
While Medicare Advantage claim denials represent 17% of initial claim submissions, including those submitted by nursing home providers, about 57% of these denials are ultimately overturned. However, MA claim denials result in a 7% net reduction in provider MA revenue, due to the dollar-weighted share of claim denials that were not overturned, according to a […]
