Skilled nursing providers adjusting to lower reimbursement rates must adapt with more internal oversight and creative programming, according to a blog published Thursday by the National Investment Center for Seniors Housing & Care.
Case managers who can look for lost revenue, follow up on denials and spot opportunities with partners will be key as more patients continue to shift from traditional Medicare to Medicare Advantage.
“To ensure healthy margins, operational efficiencies must become a key focus as cost reduction will help offset the lower reimbursement rates,” wrote Sean Hladky, vice president of finance for Cantex Continuing Care. “Enhanced case management also comes to the forefront to ensure operators are being reimbursed for all services provided.”
This year marked the first time a majority of Medicare beneficiaries enrolled in Medicare Advantage plans, with experts predicting the share will continue to rise even amid growing consumer and provider complaints about plan coverage.
Hladky wrote that operators will need to adapt not just to the lower reimbursement rates but also stricter prior authorizations and tougher utilization management practices that can depress length of stay and push more patients toward home care.
But skilled nursing providers who can innovate and be nimble in responding to a growing desire from seniors to remain in their own homes can turn that to their advantage.
“Operators are increasingly offering telehealth services such as remote patient monitoring and teletherapy to meet that need,” Hladky pointed out. “Using this, skilled nursing operators can offer follow-up care, chronic disease management and virtual therapy to current and past residents. Some skilled nursing operators are also repurposing parts of their buildings for specialty care, such as memory care units, ventilator units or offering behavioral health services. Expanding in these ways can offer higher reimbursement, bring in additional funding and meet specific needs within a community.”
As providers look to innovate, they also should consider the “Super SNF” model of care, Hladky recommended. Already pursued by some operators, it offers traditional long-term care services with hospital-like capabilities under one roof, eliminating the need for readmissions and transfers that can imperil high-acuity patients.
“They would be able to receive their complex care within the four walls of the skilled nursing property,” Hladky wrote. “Success in the post-pandemic world requires innovation and the ability to adapt. With a focus on quality outcomes, strategic partnerships, and diversification, the future of skilled nursing can be one of growth, improved care, and greater financial sustainability.”
