Skilled nursing operators and investors live and die by the changes in Medicaid and Medicare reimbursement. Over the years, the only common thread has been that the payers have wanted to pay less. And while Medicare represents a small percentage of patient days, it has an outsized impact on profitability for most providers. While many providers have been boosting their Medicare census, the Medicare lengths of stay have been declining and the payment rates have been getting squeezed, especially with Medicare Advantage plans. Is there an end in sight to this financial pressure? And if not, why do average skilled nursing facility values continue to rise with strong buyer demand?