Managed care will hit SNFs relying on Part A payments, experts say

Skilled nursing providers should be prepared for managed care to drill down on Medicare Part A residents, creating the potential for major financial problems, a long-term care expert warned on Tuesday.

Managed care experts “don't see what value we add to the equation — you need to prove it,” said Jill M. Krueger, the president and CEO of Symbria in Warrenville, IL, during a session at the LeadingAge Illinois annual meeting. “The pendulum is going to swing and they'll drill down on Medicare rates. Then you'll show the data and it will swing back, but there will be a 3-year period where you need money in your piggy banks as money from Part A moves to managed care.”

In states where there is more managed care, the length of stay is as low as 14 days, said Krueger, speaking at a session titled “Contracting with ACOs and Other Multi-Provider Arrangements” with attorney and McKnight's Ask the Legal Expert columnist John Durso.

In addition to a loss of census around a short length of stay, more patients are bypassing skilled nursing for home health, and SNFs can be excluded from narrow networks in ACOs.

Providers — especially in the nonprofit sector — should recognize the importance of relationship building.

“For-profits are really good at marketing to insurance companies and ACOs,” Krueger said. “We are trying to keep our nonprofits in business while they are out establishing relationships. We need to focus on the data — you guys do a really good job of taking care of patients and you have to be able to prove it.”

She also related an anecdote where a senior needed to be moved from a hospital to a SNF. While one nonprofit eventually called back in a day, and another two days later, the for-profit called back in 30 minutes.

“Make sure you know what your admission people are doing. Otherwise, you're going to lose a lot of opportunities. It's the same thing with the discharge planning,” Krueger said.

Durso noted ACOs often send patients to the closest nursing homes.

“The sooner you can approach them and explain to them how to have the data that they really need — that will save Medicare dollars — they will want to talk to you," he said.

Other sessions at the meeting tackled compliance, environmental health and Medicare, among other topics.

Janet Potter, CPA, MAS, a senor manager of advisory services at Marcum Accountants in Deerfield, IL, discussed when a Skilled Nursing Facility Advance Beneficiary Notice is needed. It does not need to be sent, for example, if the extended care service or item is not a Medicare benefit, but it should be issued if the services are not reasonable. It can be expensive to fail to send that notice, she warned.

“When you don't need to issue a particular form, you can issue a courtesy letter,” she recommended. This letter would say Medicare will not cover the stay due to the patient exhausting his or her benefits because he or she does not have Medicare, or if there's an issue around a qualifying stay. Providers can use CMS-R-131 as a Part B form for when those services are discontinued.

Potter added therapy reimbursements continue to be under scrutiny, and that providers need to assure they've reviewed the benefits and coverage for residents.

The conference, held at the Renaissance Schaumburg Convention Center, runs through Thursday.