With more seniors choosing Medicare Advantage, new trends in care delivery are sparking discussions around patient outcomes and cost management. According to a recent analysis conducted by NORC, a nonpartisan research organization at the University of Chicago, on behalf of the Coalition, MA patients are more likely to face longer hospital stays and less likely to be discharged to certain post-acute care settings than those on traditional Medicare. These services play a vital role in helping older adults regain independence, avoid costly hospital readmissions, and delay or prevent placement in long-term care facilities. When patients are denied access to post-acute care, the result is often worse health outcomes and higher medical costs.
The below was originally published on McKnight Long-Term Care News by Kimberly Merselas.
MA plans extend hospital stays, reduce post-acute services
Patients in Medicare Advantage plans are staying longer in the hospital but receiving considerably less post-acute care than their peers in traditional Medicare, according to a new study.
Skilled nursing facilities are often overlooked entirely by MA plans, which by 2022 were discharging directly to home health agencies 12.4% more often than Medicare Fee-for-Service.
The findings provide a deeper look into trends identified in a Senate report last fall. It showed the nation’s three largest MA insurers were “intentionally using prior authorization to boost profits by targeting costly yet critical stays in post-acute care facilities,” leading to “impossible choices.”
The new work looked at all Medicare claims and MA encounter records from 2018 to 2022 to analyze hospital discharges to PAC settings. It was conducted by NORC, a nonpartisan research organization at the University of Chicago, on behalf of the Coalition to Strengthen America’s Healthcare.
“Every patient deserves timely access to the right care in the right setting, especially after hospitalization,” coalition spokesman Ed Patru said Tuesday. “These findings raise serious concerns that Medicare Advantage plans are delaying or denying critical follow-up care that helps older adults recover, regain independence and avoid complications.”
Patru told McKnight’s Long-Term Care News that the findings “should be a wake-up call for policymakers.”
Even though MA hospital discharges to post-acute settings increased by 5.6%, from 338 to 357 beneficiaries per 1,000 discharges, the analysis still showed traditional Medicare was more likely to discharge to higher acuity PAC settings, including skilled nursing facilities, inpatient rehabilitation facilities and long-term acute care hospitals.
The coalition criticized Ms plans for limiting access to “medically necessary post-acute care services through the use of prior authorization,” although the portion of the research shared publicly did not cite any prior authorization data beyond that from last year’s Senate report, previous watchdog reports and Medicare Payment Advisory Commission reports.
Alarming trend
One way plans appear to be limiting their post-acute spending is by keeping patients in the hospital longer. The analysis showed MA patients had hospital stays that were 40% longer (seven days vs. five) on average than those with traditional Medicare.
Between 2018 and 2022, median hospital length of stay prior to discharge remained unchanged at five days for traditional Medicare beneficiaries. But it increased six days to seven days for MA beneficiaries, representing a 16% jump.
For MA patients eventually going to nursing homes, hospital stays went from an average of seven days to nine days, for a 29% increase over the study period.
“Too many seniors on MA are being left in hospital beds at the will of corporate insurance companies, who decide if and when they will be discharged to a post-acute care facility,” Patru told McKnight’s. “This is part of an alarming trend that threatens both access and quality of care for patients who rely on long-term and post-acute care services.”
Daily hospital care typically costs the government more per day, and critics also have said that patients held in hospital beds rather than moving efficiently to skilled nursing care may miss out on critical rehabilitation services.
“These services play a vital role in helping older adults regain independence, avoid costly hospital re-admissions, and delay or prevent placement in long-term care facilities,” the coalition said in a press release. “When patients are denied access to post-acute care, the result is often worse health outcomes and higher medical costs.”
In addition to drawing attention to MA plans’ use of prior authorizations and reduced spending on post-acute care, the Coalition is also behind a campaign to defend Medicaid from extensive congressional cuts.
It has launched a new advertisement highlighting the potential access-to-care crisis seniors could face if Medicaid cuts lead to the underfunding of nursing homes. The 30-second ad has been on heavy rotation in Washington, DC, as the Senate began work on its version of a reconciliation bill.
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