The Rime of the New World Mariner Medicare Advantage & SNF Reimbursement

Ken BellSkilled NursingLeave a Comment

It is a New World Mariner,
And he stoppeth wounded knee,
With long grey beard and rehab needs,
Now wherefore stopp'st thou he?

Data, data everywhere,
Still all our rates did shrink,
Data, data everywhere,
Yet all of it doth stink.

Oh Fee-for-Service Medicare,
How little hath we seen,
Advantage Plans lurk everywhere,
Such reimbursement fiends.

We searched for data, ne'er seen,
And round and round we flew.
Our Rates did split with a thunder-fit;
‘Til MAPAX steered us through!

S.T. Coleridge may not have composed Rime of the Ancient Mariner as an ode to Medicare, yet the sentiment rings true in the financial toll from Medicare Advantage (MA). The “Silver Tsunami” may indeed be the ironic metaphor that rescues skilled nursing, but only if we weather today’s reimbursement storm.

We’ve all seen the numbers. The Medicare Modernization Act of 2003 revised the MA financial formula and enrollment never looked back. While penetration varies considerably across states and even counties, more than 40% of all beneficiaries nationally now surrender choice for a growing array of supplemental benefits. “Medicare Part C” was intended to control runaway healthcare costs, yet the program has never achieved a net savings for the Federal government (MedPAC). Specific to post-acute care, MA’s rapid growth threatens to turn Skilled Nursing Facilities into Shipwrecked Nursing Facilities.

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