As Medicare Advantage Drives Rate Lower, Fed-Up CEOs Embrace Strategies That Limit Carriers’ Influence

April 26, 2021 by McKnight's Long Term Care News

Medicare Advantage aggressively penetrates the market, representing a major threat to skilled nursing providers, some of whom now find themselves clearing less per resident day through MA plans than they do in state Medicaid programs.

A panel of nursing home and senior living executives Friday called for more oversight in the face of the continuing shift. They spoke during the 2021 Legislative and Regulatory Conference hosted by the National Association for the Support of Long Term Care.

“This transfer of risk from the government to Part C Medicare Advantage plans, while it appears to be great for the federal government, if they do not establish some standards, it is in my top three threats to our profession, specifically skilled post-acute, in our coming future,” Phil Fogg, Jr., CEO and president of Marquis Companies said during an hour-long webinar. “The inability to have negotiating power with these plans puts us as one of the two, maybe three, providers that actually get paid less than the Medicaid rate for Medicare Advantage days. It threatens (our) financial stability.”

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