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Executives from Saber Healthcare Group, Creative Solutions in Healthcare and Majestic Care said nursing home operators may end Medicare Advantage contracts when reimbursement does not cover care costs. They described using cost and outcome data to negotiate higher rates and urged policy changes, while the effects of contract exits on referrals and residents remain uncertain.
Saber Healthcare Group has ended five to seven Medicare Advantage contracts in the past 24 months because, its president and founder Bill Weisberg said, the plans did not cover the cost of care. Speaking with leaders from Creative Solutions in Healthcare and Majestic Care at a Skilled Nursing News conference in Philadelphia, Weisberg said operators may leave contracts when promised referrals or better economics fail to materialize.
Weisberg said Saber ended one contract about two weeks before the conference session. He argued that Medicare Advantage (MA) plans cannot guarantee that hospitals, discharge planners or families will direct patients to a particular nursing home, making promised referral volume an unreliable reason to accept lower rates. Saber would rather replace those residents with residents whose coverage pays adequately, he said, while encouraging people to address coverage questions with their insurers.
Weisberg also described using facility data in negotiations, including cost of care, length of stay, hospital readmissions and outcomes. He said Saber has presented comparisons to plans and sought an additional $25 to $35 per day in some negotiations, with plans returning to the table and agreeing to higher rates. He characterized the approach as a negotiation in which either side may hold out.
Creative Solutions CEO Gary Blake said his company also walks away from contracts and talks with residents and families about their coverage options. He said supplemental benefits such as grocery cards can draw attention away from the adequacy of health coverage. Majestic Care CEO Paul Pruitt said operators are often asked to meet quality and cost targets without seeing the expected referrals, patients or profit. The executives also described pressure on clinical decisions when payment reductions or discharge notices come soon after a resident enters a facility.
Contract Exits Reshape Plan Negotiations
When a nursing home leaves an MA network, the decision can affect the facility’s access to residents enrolled in that plan and can require residents or families to review coverage and placement options. The executives’ accounts show how operators weigh reimbursement against occupancy and referrals, while using care and outcome data to argue that higher rates may support efficient care.
The conference discussion also points to tension between financial rules and clinical judgment. Pruitt said payment reductions or pressure to discharge can arrive early in a stay, even when clinicians believe a patient is not ready to return home. Those concerns matter to residents and families because coverage terms and discharge decisions can shape where care is delivered and how long it continues.
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Providers Weigh MA Tradeoffs
Medicare Advantage is an alternative to traditional Medicare offered through private plans. The executives did not argue that managed care’s original aim of controlling health costs is inherently wrong. Pruitt said he opposed the current results he sees, while acknowledging that MA plans are not going away.
The operators described a recurring tradeoff: plans may seek lower costs and measurable quality targets, while nursing homes say rates do not always cover the services residents need. Weisberg said Saber uses operating and clinical measures to make the case for higher payment. Blake said educating beneficiaries and their families is part of deciding whether a plan is suitable for a resident’s needs.
““We will walk away from those contracts, but we also go into them when we negotiate.””
— Bill Weisberg, Saber Healthcare Group president and founder
Effects on Residents Remain Unclear
The conference account does not identify the plans Saber dropped, the facilities or residents affected, or what alternatives were available to those residents. It also does not provide contract-level data showing how often promised referrals fell short or quantify the financial results of the rate increases Weisberg described.
The executives presented their experiences and views; the discussion does not establish how common these outcomes are across nursing home providers or MA plans. It is also unclear whether contract exits change patient access, referral patterns or care costs over time. No specific policy proposal or legislative timetable was detailed in the account.
Providers Continue Policy Advocacy
Blake said Creative Solutions is in ongoing discussions with lawmakers in Washington and called for policy changes to better support seniors and care providers. Pruitt said he has met with members of the House Ways and Means Committee to describe provider concerns, including early payment cuts and discharge pressure.
The executives said operators will continue negotiating with plans, using data and, where they judge rates inadequate, considering contract exits. The account did not announce a next negotiation date, policy decision or conference follow-up; any changes to MA rules or provider agreements remain pending.
Key Questions
Why has Saber ended some Medicare Advantage contracts?
Bill Weisberg said Saber ended five to seven contracts in the past 24 months because the plans did not cover the cost of care. He said one contract ended about two weeks before the conference session.
How does Saber seek higher reimbursement?
Weisberg said Saber analyzes cost of care, length of stay, readmissions and outcomes, then uses those measures in negotiations. He said some discussions resulted in an additional $25 to $35 per day, though the report did not specify which contracts or the broader results.
What did Creative Solutions say it does when a plan is inadequate?
Gary Blake said the company may walk away from a contract and educate residents and families about coverage choices, including other plans or traditional Medicare. The report did not describe specific resident cases or the steps needed to change coverage.
What changes are the nursing home executives seeking?
The executives called for changes to Medicare Advantage policies and described concerns about reimbursement, referrals and discharge pressure. They did not announce a specific legislative proposal or timetable.
Source: rss
