TL;DR
At a Skilled Nursing News conference in Philadelphia, executives from three nursing home providers described cutting ties with Medicare Advantage plans they said did not cover care costs. They also discussed using operating data in negotiations, educating residents about coverage choices and pressing lawmakers for changes.
Executives from Saber Healthcare Group, Majestic Care and Creative Solutions in Healthcare said they have challenged low Medicare Advantage reimbursement by ending contracts, negotiating with operating data and advocating for policy changes. Their comments came at the opening session of Skilled Nursing News’ RETHINK conference in Philadelphia, where they described financial pressures that, they said, can affect nursing home operations and care decisions.
Saber President and Founder Bill Weisberg said the company ended five to seven Medicare Advantage contracts over the past 24 months, including one about two weeks before the conference. He said those plans did not reimburse enough to cover the cost of care. Weisberg said providers may accept lower rates in expectation of more referrals, but in his view plans cannot guarantee where patients will go after leaving a hospital.
Weisberg said Saber weighs cost of care, length of stay, hospital readmissions and outcomes when making its case for higher rates. In some negotiations, he said, the company presented comparisons and requested an additional $25 to $35 per day, and plans returned to the table and agreed to a higher rate. He described the negotiations as “kind of like you’re playing a game of chicken.”
Creative Solutions CEO Gary Blake also said the company is willing to leave contracts and educates residents and families about plan choices, including traditional Medicare. Majestic Care CEO Paul Pruitt criticized a system he said asks providers to meet quality and cost goals without reliably producing more referrals or better financial returns. The executives also pointed to pressure on clinicians when coverage decisions or discharge expectations conflict with their judgment about a patient’s readiness.
Contract Decisions Shape Care Economics
Medicare Advantage plans are a source of coverage for nursing home residents, while providers must meet the costs of staffing and delivering care. When a facility decides a plan’s rates do not cover those costs, ending a contract can change which residents it serves and how families navigate coverage. The executives’ accounts show that contract negotiations can affect both provider finances and resident options.
The statements also highlight a tension between financial terms and clinical decisions. Pruitt said providers can face payment reductions or discharge pressure soon after a patient arrives, even when clinicians believe more care is needed. The comments describe operators’ concerns; the conference discussion does not establish how often these situations occur across the sector or whether the plans involved would characterize them the same way.
How Providers Approach Plan Negotiations
Medicare Advantage is a privately administered alternative to traditional Medicare. The executives discussed how nursing home operators weigh participation in these plans against reimbursement, referral expectations and the work involved in meeting plan requirements. Their examples reflect the experiences and views they shared at the conference, rather than a comprehensive accounting of contracts across the industry.
Weisberg said Saber may cancel contracts but also uses comparative operating data to seek higher rates. Blake described educating residents and families about whether a plan suits their needs, saying supplemental benefits such as grocery cards can draw attention away from coverage and care considerations. He said families may want to compare available plans or consider traditional Medicare.
“So it’s kind of like you’re playing a game of chicken.”
— Bill Weisberg, Saber Healthcare Group president and founder
Scale of Contract Disputes Remains Unclear
The conference accounts do not identify the Medicare Advantage plans involved in Saber’s cancellations or provide contract terms, facility-level figures or independent data on the effects of those decisions. The source material also does not establish how frequently providers face early payment reductions or discharge pressure, or how plans respond to the executives’ broader criticisms.
It is also unclear whether Saber’s negotiated increases of $25 to $35 per day apply broadly or only to particular contracts and circumstances. The executives described their own experiences; the discussion did not provide a sector-wide comparison of reimbursement or patient outcomes.
Providers Continue Policy Advocacy
Blake said Creative Solutions is in ongoing discussions with lawmakers in Washington. Pruitt described meeting with members of the House Ways and Means Committee to raise concerns about Medicare Advantage policies and their effect on seniors and care providers. The executives called for changes, but the conference discussion did not specify proposed legislation, a timetable or a pending federal action.
In the near term, providers will continue to decide whether to negotiate, accept or end individual plan contracts. The next developments will depend on those negotiations and on whether lawmakers take up the concerns the executives said they are raising.
Key Questions
What did Saber say about ending Medicare Advantage contracts?
Saber President and Founder Bill Weisberg said the company ended five to seven contracts over the previous 24 months, including one about two weeks before the conference, because the plans did not cover its cost of care.
How does Saber seek higher reimbursement?
Weisberg said Saber uses data on care costs, length of stay, readmissions and outcomes in negotiations. He said some plans agreed to increases of $25 to $35 per day after the company presented comparative data.
What did Creative Solutions say it tells residents?
CEO Gary Blake said the company educates residents and families about coverage options, including other Medicare Advantage plans and traditional Medicare. He said they discuss whether a resident’s current plan is a good fit.
What changes are the executives seeking?
The executives called for changes to Medicare Advantage policies. Blake said Creative Solutions is in discussions with lawmakers, and Pruitt said he has raised provider concerns with members of the House Ways and Means Committee. They did not identify a specific pending policy proposal or timetable.
Source: rss
