A study of nearly 300,000 Medicare beneficiaries suggests that Medicare Advantage patients have fewer home health visits and worse outcomes than traditional Medicare beneficiaries.
Rachel Prusinski, a health services researcher at Women's Medicine, and colleagues examine the increasing impact on health care of private Medicare Advantage plans, which are offered to adults 65 and older as an alternative to federally provided plans. did. the study Published in JAMA Health Forum on March 1st.
Home health care is a small but important part of the care system that aims to keep patients away from long-term care and nursing homes by allowing care and treatment visits in patients' homes.
“Patients in Medicare Advantage plans are losing access to home health care across the board,” said Prusinski, a researcher and assistant professor of rehabilitation medicine at the University of Washington School of Medicine's Health Workforce Research Center.
There are currently approximately 30 million Medicare Advantage beneficiaries, which recently surpassed the number of traditional Medicare beneficiaries in the United States. There are nearly 4,000 Medicare Advantage plans offered by insurance companies. In some ways, these plans offer more services than federal Plans A and B, such as dental and vision coverage. However, Medicare Advantage plans also tend to have limitations that affect the cost of hospital and outpatient services, such as out-of-pocket limits. About approved services and network coverage, and policies that often require prior authorization for care.
Home health care is especially important for older Americans and is often not needed until patients are in medical distress. In 2021, 3 million traditional Medicare beneficiaries received home health care at a cost of $17 billion. It's unclear how much home health care costs for Medicare Advantage patients, but Prusinski's findings suggest the number is likely lower.
Prusinski won a grant to study data provided by a major home health care provider. Researchers looked at anonymous patient information from 2019 to 2022 for more than 285,000 home health care recipients aged 65 and older. The data spans 102 home health care company locations in 19 states.
The researchers found that Medicare Advantage patients had shorter lengths of stay in home health care, had fewer visits from nursing/treatment clinicians and home health aides, had lower rates of improvement in self-care and mobility, and had lower rates of improvement from home health care to the community. We found that the discharge rate was high. .
The authors stated that the combination of increased community discharge rates and decreased functional improvement could negatively impact patient independence and increase caregiver burden in Medicare Advantage enrollees.
“We know that the degree of cognitive impairment and the amount of help patients receive at home really impacts patient outcomes,” Prusinski says. “We've been able to really reconcile some of these differences, and we know that these challenges in the health care system are spilling over to patients, and that Medicare Advantage is limiting some care. Not only is it giving money to health insurance companies, it's potentially worsening patient outcomes.”
Data show that Medicare Advantage patients are 3% less likely to have improved mobility, 4% less likely to be able to care for themselves, and 3% less likely to be discharged to the community despite less functional improvement. has been shown to be 5% higher. On average, Medicare Advantage patients received a treatment duration that was 1.62 days shorter.
“These are small percentages, but we controlled for any differences between these two patient populations,” Prusinski said. “Even if a patient has the same level of medical complexity, the same difficulty in getting around the home, the same level of home support, and the same caregiver support, even when comparing apples to apples, Medicare Advantage “Patients still had fewer and fewer services available to them, and their functional scores did not improve as much as they did for traditional Medicare patients.”
The researchers' findings support claims that Medicare Advantage plans ration their customers' care, including home health care, and appear to value profitability over patient well-being, Prusinski said. Ta.
“One of the main motivations for studies like this is the fact that health care providers have been experiencing these burdens from Medicare Advantage plans for many years,” she said. “These limitations on what can be provided to patients are unique to Medicare Advantage.”
This research was supported by the Learning Health Systems Rehabilitation Research Network through a grant (5P2CHD101895-04) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development to Brown University.
Related: Download video soundbites Discuss the research results with Mr. Prusinski.
