SNFs contracting with MA payers should recognize that the financial model underlying MA plan payments creates built-in incentives to restrict post-acute utilization and hold down facility rates.
“In theory, this (Medicare Advantage) payment system should save the Medicare system money because the risk-adjusted benchmark that Medicare estimates for each plan should run, on average, equal to what Medicare would actually spend on a plan’s enrollees if they had enrolled in traditional Medicare instead. In reality, the risk-adjusted benchmark estimates are far above traditional Medicare costs. This causes Medicare – really, taxpayers – to spend more for each person who is enrolled in Medicare Advantage than if that person had enrolled in traditional Medicare.”
— USC Schaeffer Center for Health Policy & Economics, 26 November 2024
Mackleby, Grace, and Erin L. Duffy. Medicare Advantage Costs Taxpayers 22% More Per Enrollee: Here’s How Payment Reform Could Help Close the Gap. USC Schaeffer Center for Health Policy & Economics, 26 November 2024. https://schaeffer.usc.edu/research/medicare-advantage-costs-taxpayers-22-more-per-enrollee-heres-how-payment-reform-could-help-close-the-gap/
✔ Comply with every payer's rules
✔ Equip your team with the Playbook
✔ Monitor rates and payer trends
