Nursing home surprise: Advantage plans may shorten stays to less time than Medicare covers

[Northeast Agent]

[EXTERNAL LINK] - Nursing home surprise: Advantage plans may shorten stays to less time than Medicare covers

Jill Sumner, a vice president for the American Health Care Association, which represents nursing homes, said her group has “significant concerns” about large Advantage plans cutting off coverage. “The health plan can determine how long someone is in a nursing home typically without laying eyes on the person,” she said.

The problem has become “more widespread and more frequent,” said Dr. Rajeev Kumar, vice president of the Society for Post-Acute and Long-Term Care Medicine, which represents long-term care practitioners. “It’s not just one plan,” he said. “It’s pretty much all of them.”

 

[somarco]

“The health plan can determine how long someone is in a nursing home typically without laying eyes on the person,” she said.

That is one of my major complaints about managed care. Bean counters can override the attending physician recommendation for anything and everything. Not just SNF stays, but anything that can run up the bill and get into the carriers pocket.

 

[Newby]

That is one of my major complaints about managed care. Bean counters can override the attending physician recommendation for anything and everything. Not just SNF stays, but anything that can run up the bill and get into the carriers pocket.

But free dental!

 

[BALDELMO]

And $50 a month to pay their utilities! Sad

 

[Midlevel]

Charlene Harrington, a professor emerita at the University of California-San Francisco’s School of Nursing and an expert on nursing home reimbursement and regulation, said nursing homes have an incentive to extend residents’ stays. “Length of stay and occupancy are the main predictor of profitability, so they want to keep people as long as possible,” she said. Many facilities still have empty beds, a lingering effect of the COVID-19 pandemic.

When to leave a nursing home “is a complicated decision because you have two groups that have reverse incentives,” she said. “People are probably better off at home,” she said, if they are healthy enough and have family members or other sources of support and secure housing. “The resident ought to have some say about it.”




Oh, there is another side to the story. I feel worse for the people on Original Medicare who are under observation for days or spend 2 nights in the hospital and then don't qualify for SNF at all. At least if they have an MAPD they don't have to be in the hospital 3 days to even start getting SNF. Good and bad of both I guess.

 

[somarco]

But free dental!

LD will like that . . .

 

[Yagents]

It seems like there are a lot of recent articles on MAPD........mmmmm

https://healthpayerintelligence.com...tage-payment-system-contribute-to-overpayment

 

[rousemark]

To me it borders on dishonest deception when they adverestise "covers the same thing Medicare does' when they know most people will think that means they will think that means they will pay the same as Medicare pays whcih is not true.

The discharge nurse visted my room this morning asking for my information. She told me how fotunate I was that I had Original Medicare and a supplement. One the things she brought was this fewer SNF days.

 

[wehotex]

[EXTERNAL LINK] - Nursing home surprise: Advantage plans may shorten stays to less time than Medicare covers

Jill Sumner, a vice president for the American Health Care Association, which represents nursing homes, said her group has “significant concerns” about large Advantage plans cutting off coverage. “The health plan can determine how long someone is in a nursing home typically without laying eyes on the person,” she said.

The problem has become “more widespread and more frequent,” said Dr. Rajeev Kumar, vice president of the Society for Post-Acute and Long-Term Care Medicine, which represents long-term care practitioners. “It’s not just one plan,” he said. “It’s pretty much all of them.”

YEP! I’ve seen this happen with at least 4 of my members that I know about. If their kid works in a SNF, they will usually inquire about a Med Supp.

 

[somarco]

It seems like there are a lot of recent articles on MAPD........mmmmm

https://healthpayerintelligence.com...tage-payment-system-contribute-to-overpayment

Probably because of the FREIGHT TRAIN . . .