Medicare Advantage should glean info on post-acute care, study finds

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New data shows that Medicare Advantage beneficiaries generally use fewer post-acute care services than enrollees in fee-for-service Medicare, and also experience worse outcomes. For that reason and others, authors of a new study in JAMA Health forum said Medicare Advantage plans should seek feedback from patients regarding how helpful they found post-acute care after being hospitalized.

This consideration should be top-of-mind for policymakers, authors said, due to MA's continued growth. This growth, they contend, means the insurers who run the plans are increasingly attempting to cut back on the perceived inefficient use of post-acute care services.

WHAT'S THE IMPACT

After a hospitalization, Medicare beneficiaries often receive post-acute care services from skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), long-term care hospitals, outpatient clinics or home health agencies. Medicare also covers post-acute care without a hospital stay through noninstitutional facilities, such as home health agencies and outpatient rehabilitation facilities. 

Traditional Medicare spending on postacute care totaled $57.9 billion in 2020, prompting questions about how Medicare can expand payment models that promote more efficient use of postacute care services.

Traditional Medicare and MA have different incentives that affect post-acute care use. According to the authors, traditional Medicare's largely fee-for-service reimbursement system potentially encourages overuse of post-acute care services. In contrast, capitated rates paid to MA plans may incentivize plans to steer patients to less expensive settings, limit service duration or refuse prior authorization for post-acute care.

Data showed that fewer MA enrollees reported using post-acute care services than TM beneficiaries. Among participants with post-acute care use, MA enrollees had shorter duration of services, but the services did not differ from those used by TM beneficiaries in terms of location of care or reason for using these services. Enrollees in MA who used post-acute care services reported less functional improvement while receiving these services.

Among those with conditions that may make them more likely to use post-acute care services – such as arthritis, osteoporosis, or hip or knee surgery – MA enrollees often reported less use of post-acute care and less functional improvement while using these services. Despite that, MA enrollees had better outcomes for some measures, such as readmissions and successful discharge.

The findings have implications for Medicare's value-based payment initiatives. Based on the evidence that post-acute care spending contributes to variation in TM spending, several Medicare payment models in addition to MA have targeted reducing unnecessary use of post-acute care services. According to evaluations of administrative data, the Medicare Shared Savings Program and mandatory bundled payments achieved savings by decreasing post-acute care use without adverse outcomes.

However, findings also suggest that self-reported data from Medicare beneficiaries may introduce important evidence about potential declines in patient satisfaction. These "should be investigated as Medicare seeks to expand payment models that promote more efficient use of postacute care services," authors wrote.

THE LARGER TREND

While 71% of Medicare Advantage enrollees are generally happy with their health plan, many are confused by the features of their plan and feel they're either being overbilled or are struggling with prior authorization practices, according to a new survey from Retirement Living.

Over the past year, one in 10 beneficiaries believed they were overbilled for their Medicare Advantage plan, while almost 20% of enrollees had challenges receiving care due to delays caused by the prior authorization process, the numbers showed.

According to recently released data from the Centers for Medicare and Medicaid Services, Medicare Advantage now provides Medicare coverage for just over half of eligible beneficiaries. In January 2023, 30.19 million of the 59.82 million people with both Medicare Part A and Part B were enrolled in a private plan, the numbers show.

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com