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Executives from three nursing home providers said they have walked away from Medicare Advantage contracts they considered inadequate, while using cost and care data to negotiate higher rates. They also called for policy changes, citing financial pressure and concerns that coverage decisions can conflict with clinical judgment.
Executives from Saber Healthcare Group, Creative Solutions in Healthcare and Majestic Care said they have challenged Medicare Advantage payment terms by ending contracts, negotiating for higher rates and urging policy changes. Their comments at the opening session of the RETHINK conference in Philadelphia highlighted a financial and care-delivery dispute: providers say some plans do not reimburse enough for nursing home care, while promised referral gains may not follow.
Saber President and Founder Bill Weisberg said the company had ended five to seven contracts in the previous 24 months, including one about two weeks before the conference session. He said those contracts did not cover the cost of care. Weisberg argued that accepting a lower rate in return for more referrals can fail because plans cannot determine where patients or their families choose to receive care.
Weisberg said Saber weighs cost of care, length of stay, hospital readmissions and outcomes when it negotiates. He said the company has presented comparisons to plans and sought an additional $25 to $35 per day in some negotiations, with plans agreeing to the higher rate. The report does not specify how many negotiations resulted in those increases or the period over which they were measured.
Gary Blake, CEO of Creative Solutions, said his company also walks away from contracts it considers inadequate and talks with residents and families about coverage choices. He said residents may have other plan options or traditional Medicare. Paul Pruitt, CEO of Majestic Care, said providers are often asked to meet quality and cost measures on the expectation that performance will improve their finances, but he said the expected referrals, patients and profits do not always materialize.
Contract Decisions Affect Care and Revenue
The executives’ comments describe a direct trade-off for nursing home operators: keeping a plan contract may preserve access for its members, but low reimbursement can leave a provider carrying costs it says the rate does not cover. Ending a contract can put pressure on operators to replace that business with other residents, as Weisberg described, and may prompt residents and families to reconsider their coverage.
The debate also concerns how financial rules affect care inside facilities. Blake and Pruitt said payment reductions or pressure to discharge patients can put financial requirements in tension with clinicians’ judgments about whether a person is ready to leave. Those were providers’ accounts of the problem; the conference report did not present plan responses or independently assess the frequency of such cases.
Providers’ Case for Higher Rates
Medicare Advantage is a privately administered alternative to traditional Medicare. The conference discussion focused on how nursing home providers and plans negotiate payment and how those arrangements can influence referrals, length of care and discharge decisions.
Weisberg said Saber uses operational and outcome data to argue that higher daily payments can still support efficient care. Blake said supplemental benefits, including grocery cards, can attract members, but he believes residents should also weigh the adequacy and quality of health care. The source report did not compare specific plans or independently evaluate the benefits mentioned.
The executives described walking away as one negotiating tool, alongside presenting data and speaking with residents and families. Their experiences represent the views of three provider leaders at one conference session; the report does not establish how broadly those practices or outcomes apply across the nursing home sector.
““So it’s kind of like you’re playing a game of chicken.””
— Bill Weisberg, Saber Healthcare Group president and founder
Scale of Contract Cuts Is Unclear
The conference report does not identify the plans involved in Saber’s contract endings, the facilities or residents affected, or the financial impact on the company. It also does not provide plan representatives’ responses to the executives’ criticism.
The reported $25 to $35 daily increase is an amount sought in some negotiations, according to Weisberg; the source does not detail the number of agreements reached, their terms or the resulting effect on care costs. The executives’ remarks also do not establish how often referral commitments fail across the industry or how frequently payment decisions prompt discharge pressure.
Operators 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 and advocating for changes to Medicare Advantage policies. The executives said providers need to keep raising concerns about reimbursement and the effect of plan decisions on older adults and care teams.
No specific legislative proposal, timetable or policy change was announced in the conference discussion. For now, the executives described contract negotiations, resident education and advocacy as ongoing responses to the pressures they outlined.
Key Questions
Why did Saber end some Medicare Advantage contracts?
Weisberg said Saber ended five to seven contracts over 24 months because they did not cover the cost of care. He also said promised referral increases may not occur.
How does Saber negotiate for higher payments?
Weisberg said Saber uses data on care costs, length of stay, readmissions and outcomes to make its case. He said the company has sought daily increases of $25 to $35 in some negotiations, though the report gives no count of agreements.
What did Creative Solutions say it tells residents?
Blake said the company discusses coverage options with residents and families, including other Medicare Advantage plans and traditional Medicare. The source does not describe specific residents’ decisions or outcomes.
What changes are the executives seeking?
Blake and Pruitt called for policy changes and said they have raised concerns with lawmakers. They cited reimbursement pressures and cases in which payment or discharge decisions may conflict with clinicians’ judgments. No specific proposal or timeline was reported.
Source: rss
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