This shift creates both opportunities and challenges, with potential benefits in care coordination and cost efficiency but also risks related to prior authorization hurdles and narrower networks. Ultimately, nursing homes must strategically navigate the evolving MA landscape to ensure financial stability and maintain quality resident care.
Of the many significant factors affecting the skilled nursing industry in the last five years, Medicare Advantage was named as a major disruptor, as cost reports show a shift in operating margins with more facilities struggling financially.
Stephen Taylor, principal of senior living and care segment leader for CliftonLarsonAllen (CLA), said MA has had “one of the most profound” impacts on the sector, especially as it grew during Covid. Medicare Advantage’s growth has significantly reshaped SNF payer dynamics, he said.
Taylor earlier this month spoke about major factors shaping the sector along with colleague Seth Wilson, CLA principal of data analytics, during a webinar companion to its 39th annual cost report. Other influences named by CLA experts were quality and occupancy, labor costs, Medicaid reliance, demographic shifts and industry consolidation.
Stulick, A., (2024, November 19). Medicare advantage proves to be the ‘Most profound’ disruptor for nursing homes, reshaping payer dynamics. Skilled Nursing News. https://skillednursingnews.com/2024/11/medicare-advantage-proves-to-be-the-most-profound-disruptor-for-nursing-homes-reshaping-payer-dynamics/
Siddiqi, Z. (2024, November 15). CLA’s State-by-State Cost Report Shares Key Metrics Behind Regional Operational and Financial Variation. Skilled Nursing News. https://skillednursingnews.com/2024/11/clas-state-by-state-cost-report-shares-key-metrics-underlying-regional-operational-and-financial-variation/
2024 State-by-State Financial and Operational Metrics. (n.d.). https://www.claconnect.com/en/resources/tools/24/state-by-state-financial-and-operational-metrics
Improve Medicare Advantage reimbursements with payer contract management that puts payer rules in the hands of clinicians & billers.
