TL;DR
Get everyday helpers delivered free — and shop member deals
- Fast, free delivery on millions of items
- Access to Prime Big Deal Days deals on October 6–7
- Prime Video, Amazon Music and more included
Executives from three large skilled nursing operators told Skilled Nursing News’ RETHINK conference that they routinely terminate Medicare Advantage contracts that don’t cover the cost of care, use data to negotiate higher rates, and are lobbying Washington for policy change.
Executives from three large nursing home operators said this week they are willing to terminate Medicare Advantage contracts that do not cover the cost of care, with Saber Healthcare Group ending five to seven such contracts over the past 24 months — including one two weeks ago. Speaking at the opening session of Skilled Nursing News’ RETHINK conference in Philadelphia, the leaders described low reimbursement, unfulfilled referral promises and mounting pressure from MA plans as growing threats to skilled nursing finances.
Saber President and Founder Bill Weisberg said the company has ended five to seven MA contracts in the past two years, most recently one terminated two weeks ago because the plan did not cover the cost of care. He said accepting lower reimbursement in exchange for promised referral volume rarely works because MA plans cannot dictate where patients are discharged.
Rather than accept low rates, Weisberg said Saber cancels contracts and pushes its leaders to replace those patients with properly paying residents, shifting the burden back to residents to dispute coverage with their insurers. He also said operators can strengthen their negotiating position with data — Saber analyzes cost of care, length of stay, hospital readmissions and outcomes to argue that higher reimbursement still produces more efficient care. In some cases, plans returned to the table after Saber presented comparative data and secured an additional $25 to $35 per day.
Gary Blake, CEO of Creative Solutions in Healthcare, said his company also walks away from contracts while educating residents about their benefits. Paul Pruitt, CEO of Majestic Care, said MA plans profit while operators gain nothing in referrals or margin, and that he is advocating in Washington — including meetings with the Ways and Means Committee — for policy changes.
Why Providers Are Cutting MA Ties
The comments from three large operators illustrate a broader tension in post-acute care: Medicare Advantage enrollment keeps growing, but many skilled nursing operators say plan rates do not cover their costs. Walking away from contracts is a financially risky strategy — it can reduce census — but these executives argued the alternative of accepting inadequate rates is worse.
The discussion also highlights a consumer-side dynamic. Blake said providers are coaching families to question whether their MA plan serves them well, pointing them toward alternative plans or traditional Medicare. If more operators adopt that approach, it could increase pressure on MA plans from both providers and beneficiaries.
The Referral Promise That Fell Short
Medicare Advantage was originally intended to use managed care to control health care costs. But Pruitt said the system has become an increasingly difficult game for providers, who are asked to meet quality and cost metrics with the expectation of better economics that often do not materialize.
Blake added that MA plans’ supplemental benefits — such as $25 grocery cards — can overshadow the adequacy of actual health coverage unless residents are made aware of the difference. Pruitt also described clinical friction, saying facilities can receive payment reductions or discharge pressures within days of a patient’s admission, even when clinicians believe the patient is not ready to return home.
“They don’t have control over the discharge planners or where families want to go, or the communities. So there’s no argument there that wins with me.”
— Bill Weisberg, President and Founder, Saber Healthcare Group
Unanswered Questions on MA Strategy
The executives described their own companies’ experiences, but it is not clear how widely other operators are adopting the walk-away strategy or how MA plans are responding industry-wide. The panel did not provide data on how terminating contracts affected census or revenue at the three companies.
It also remains unclear whether the advocacy efforts in Washington will produce policy changes, and no specific legislation was cited in the discussion. The MA plans involved in the terminated contracts were not named.
Washington Talks and Rate Battles Ahead
Blake said Creative Solutions is in ongoing discussions with lawmakers in Washington and urged other providers to keep pushing for policies that better support seniors and care organizations. Pruitt said he will continue meeting with members of Congress, including the Ways and Means Committee, to argue against rapid discharge and payment-cut practices.
On the operational side, Weisberg indicated Saber will continue terminating underpaying contracts while using outcome data to negotiate higher rates when plans return to the table. The RETHINK conference continues this week in Philadelphia.
Key Questions
How many Medicare Advantage contracts has Saber terminated?
Bill Weisberg said Saber has ended five to seven contracts over the past 24 months, including one two weeks ago because the plan did not cover the cost of care.
Why do nursing home operators say referral promises fall through?
According to Weisberg, MA plans cannot control discharge planners, family preferences or which communities patients choose, so promised increases in referral volume often do not materialize.
What rate increases has Saber negotiated using data?
Weisberg said that after presenting comparative data on cost of care, length of stay, readmissions and outcomes, some plans returned to negotiate and Saber secured an additional $25 to $35 per day.
Are these companies seeking policy changes?
Yes. Blake said Creative Solutions is in ongoing talks with lawmakers in Washington, and Pruitt said he has met with the Ways and Means Committee to advocate for changes to MA practices.
What are providers telling residents about their MA plans?
Blake said Creative Solutions educates families that supplemental benefits like grocery cards can overshadow coverage adequacy, and that better plans or traditional Medicare may be available.
Source: rss
Fall Picks
fall essentials
As an affiliate, we earn on qualifying purchases.
