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Medicare advantage eats into margin gains for skilled nursing facilities

April 29, 2019 In The News 3 min read
Betsy Rust
Skilled nursing providers showed gains in Medicare margins from 2016-17, but those gains masked the ongoing negative effects of Medicare Advantage. Betsy Rust weighs in via Skilled Nursing News.

 Money graphsBetsy Rust, leader of Plante Moran’s senior care strategy and operations consulting practice, recently spoke with Skilled Nursing News about our annual Make the Mark SNF benchmarking report. The report highlights that despite overall gains in the Medicare margins between 2016 and 2017, the results mask the negative effects of Medicare Advantage.

“What you can’t tell from this data is the impact on the other payer sources, and that Medicare fee-for-service continues to decline as Medicare Advantage grows and as volumes decline on post-acute utilization from the pressure of those managed care payers,” says Betsy. The upcoming shift to the Patient-Driven Payment Model (PDPM) won’t improve the situation, as Medicare Advantage payers don’t pay providers based on RUG rates now, and they will likely not opt to pay based on PDPM after October 1.

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