Home Nurse Facilities Nursing facilities must weather the Medicare Advantage ‘reimbursement storm’

Nursing facilities must weather the Medicare Advantage ‘reimbursement storm’



With Medicare Advantage earnings “significantly lower” than fee-for-service, new analysis from Zimmet Healthcare Services Group finds, qualified nursing facilities must weather today’s “reimbursement storm” in order to meet the challenge. to the incoming wave of baby boomers who need installation services.

In the meantime, Zimmet suggests operators use plant data to improve AD performance.

“Most MA applications were submitted by SNFs with at least a three-star rating, but in areas with less bed saturation, two stars were not uncommon,” the report said. “There was no correlation between the 5-star rating and episodic earnings, while the 30-day hospital readmission rate explained less than 20% of the variation in payment.”

NFCs with best results and low costs can market their ‘value proposition’ to MA plans using benchmarking, county-level metrics offered through Zimmet’s CORE Analytics through its Medicare Advantage Post-Acute eXchange (MAPAX) .

MAPAX, which was launched in April, compares MA performance on a “local peer group” basis, taking into account market-based revenue and value metrics.

“Providers know very little about their Medicare Advantage performance, specifically market capture levels, then revenue and results in a specific market,” said Vincent Fedele, partner and chief analytics officer at Zimmet. “We’re trying to neutralize and level the playing field in this regard, and publish the information on the Medicare grant side, based on our own proprietary dataset for incoming claims.”

Operators could then compare their revenues and results to other facilities of the same size and market.

“There is a lot of data available for Medicare’s service charge (FFS). There are companies that sell this data for a lot of money – there is hardly any on Medicare Advantage, ”added Marc Zimmet, CEO of the consulting firm. “When nursing homes are negotiating or dealing with Medicare Advantage plans and the rates are very low, the nursing homes could call the Medicare Advantage plan and try to get the rates increased… we have these metrics to really quantify the costs. performance of installations.

CORE is the consulting firm’s software data company; analysts get relevant data directly from SNF complaints submitted to the company. Fedele said the Centers for Medicare & Medicaid Services (CMS), or any other governing body, does not publish this type of data.

“We’re joking that insurance companies are going to hate this product because it sheds light on this data black hole so well,” Zimmet said. “Insurance plans have all the information, but they don’t share it.

CORE has received submissions from over 3,000 qualified nursing facilities in 49 states since its inception in October 2019 – these submissions represent over 30% of all SNF Medicare Part A claims nationally.

For MAPAX, 1,000 of these suppliers downloaded MA SNF complaints from March 1 to August 31 of this year. Zimmet hopes that most of CORE’s 3,000 users will be engaged and contribute to its flagship product MAPAX by early next year.