Saturday Q and A

Dr. Lee writes

Thank you for all your generous information over the years. The nursing home I work with is intentionally working to switch my patients away from Medicare Advantage and onto other insurance programs. What do I do?


Dr. Lee,

Approach the administrator. Tell her that Medicare Advantage is the only insurance program that compensates you adequately for the value you generate in the nursing home environment.



Advise them that, should your Medicare Advantage census fall below a certain level, you’ll be obliged to stop seeing patients in their home (you don’t have to share that level with them).



Then, decide for yourself what that level would be—and follow through.



Nursing home patients are a big part of your Medicare Advantage success, but better no nursing home, then working in one for fee-fo-service rates—that’s a sure path to financial loss.



Nursing homes sometimes have side deals with local agents to shift their resident’s insurance coverage. Others enhance their revenues by getting them on Medicaid even if it is not in the patient’s financial interest to do so (yes, some nursing homes do better with patients on medicaid).



There are nursing homes that will value your presence.



Keep looking until you find one—the professional rewards are boundless.



Don’t try to influence the patient’s insurance choice yourself, unless asked. That’s neither professional nor appropriate. Deliver great care and let the decision come to you.



If you’re asked, refer them to an insurance agent with whom you’re comfortable.



Bonus tip

One physician has reported success by contacting the provider relations office at one of his larger Medicare Advantage insurance partners and telling them they are losing covered lives due to the influence of the nursing home administration.

In this case, the nursing home was part of a large system.

The insurance company pushback staunched the loss.

If you try it, let me know how it works in a smaller situation.



Read Medicare Advantage Mastery and you can start yourself on your path to mastery as well.