Reimbursement Changes

Skilled nursing owners and operators are trying to figure out how to take advantages of the recent changes to reimbursement. For profit nursing homes spend time and resources on how to maximize reimbursement due to changes in the Medicare Value‑Based Purchasing (VBP) program, the negative impacts of the One Big Beautiful Bill Act (OBBBA), and the growing influence of Medicare Advantage plans.

Changes to the VBP model have made it harder for organizations like ArchCare and Ignite Medical Resorts to maintain stable payments, particularly due to added performance measures and reduced updates that offset automatic rate increases, prompting efforts to improve clinical outcomes such as reducing infection‑related hospitalizations.

Providers are also preparing for potential shifts in Medicaid reimbursement tied to quality and staffing metrics under OBBBA by stress‑testing
budgets and building predictive models. As Medicare Advantage continues to expand, operators are negotiating managed‑care contracts with strong data
support, focusing on metrics like readmission rates and leveraging detailed patient assessment coding to better align negotiated rates with underlying care costs