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Executives from Saber Healthcare Group, Creative Solutions in Healthcare and Majestic Care said at a Philadelphia conference that low reimbursement and operational pressures have led some nursing home providers to leave Medicare Advantage contracts. Saber’s Bill Weisberg said his company ended five to seven contracts in the past 24 months; the executives also cited data-based negotiations, resident education and advocacy for policy changes.
Executives from Saber Healthcare Group, Creative Solutions in Healthcare and Majestic Care said they have faced financial and clinical pressures in negotiating with Medicare Advantage plans, including rates they say do not cover the cost of nursing home care. At the opening session of Skilled Nursing News’ RETHINK conference in Philadelphia this week, they described ending some contracts, using care data to seek higher rates and pressing lawmakers for changes.
Saber President and Founder Bill Weisberg said the company ended five to seven contracts over the past 24 months, including one about two weeks before the conference, because the plans did not cover its cost of care. He said promised increases in referrals have not reliably made up for lower reimbursement. In his account, plans cannot control where discharge planners, families or communities direct patients.
Weisberg said Saber uses cost of care, length of stay, hospital readmissions and patient outcomes in negotiations. He described cases in which the company presented comparative data, sought an additional $25 to $35 per day and received a higher rate. He said the company may leave a contract but can also return to negotiations with evidence about the care it provides.
Creative Solutions CEO Gary Blake said his company is also willing to leave contracts and talks with residents and families about plan choices. He said supplemental benefits, including grocery cards, can draw attention away from the adequacy of coverage. Majestic Care CEO Paul Pruitt said providers are asked to meet quality and cost measures without always receiving better economics, and described pressure to discharge patients even when clinicians believe they are not ready to return home.
Contract Rates Shape Nursing Home Choices
Leaving a plan can change the choices available to residents and families, as well as the flow of patients to a nursing home. The executives said that a plan’s promise of more referrals may not materialize, while accepting low rates can leave a provider absorbing costs it says are not covered. Their comments show how payment negotiations can affect both facility finances and care operations.
The executives also described a tension between administrative requirements and clinical judgment. Pruitt said facilities can face payment reductions or discharge pressure soon after a patient arrives, including when staff believe the person still needs care. These are the executives’ accounts; the conference report does not provide plan responses or independent comparisons of reimbursement and care outcomes.
How Providers Negotiate With Plans
Medicare Advantage is privately administered health coverage for people eligible for Medicare. Nursing home providers negotiate payment and other contract terms with plans when they care for members. The executives discussed managed care’s stated cost-control aims alongside what they described as difficult reimbursement and operational conditions for skilled nursing operators.
Weisberg said Saber weighs whether rates cover care and whether referral commitments produce results. Blake described explaining plan alternatives to residents and families, including traditional Medicare. The executives’ conference remarks also turned to advocacy: Blake said Creative Solutions is in discussions with lawmakers in Washington, while Pruitt described meeting with the House Ways and Means Committee to raise provider concerns.
“So it’s kind of like you’re playing a game of chicken.”
— Bill Weisberg, Saber Healthcare Group president and founder
Plan Responses and Contract Effects
The conference account does not identify the plans whose contracts Saber ended, disclose the contract terms or provide responses from insurers. It also does not establish how many residents were affected, whether patients faced interruptions in care, or how frequently promised referrals fell short across the companies’ contracts.
The executives’ reported rate increases and operational experiences are not accompanied by independent data in the source report. It remains unclear whether the lawmakers’ discussions will produce specific proposals, and no policy changes or timeline were announced at the session.
Advocacy and Future Negotiations
Blake said Creative Solutions is continuing discussions with lawmakers in Washington, and Pruitt said he has advocated to members of the House Ways and Means Committee. The executives called for changes they believe would better support seniors and the organizations caring for them, but did not name a specific bill or legislative milestone.
In the near term, the companies’ described approach is to keep negotiating with plans, use operational data to support rate requests and, where they judge a contract does not work, consider ending it. Whether those steps lead to broader policy changes or different contract terms remains to be seen.
Key Questions
What did the nursing home executives report?
They described low reimbursement, limited referral benefits and operational pressures in some Medicare Advantage contracts. Saber’s Bill Weisberg said his company ended five to seven contracts over 24 months.
Why did Saber end some contracts?
Weisberg said the contracts did not cover the cost of care. He also said lower rates offered in exchange for more referrals may not pay off when plans cannot control where patients go.
How does Saber seek higher payment rates?
Weisberg said Saber uses data on costs, length of stay, readmissions and outcomes to make its case. He cited instances in which the company sought an additional $25 to $35 per day and received a higher rate.
What changes are the executives seeking?
They called for better support for seniors and providers and said they were raising concerns with lawmakers. The conference report did not identify a specific proposed law or announced policy change.
Source: rss
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