SNFs should expect similar patterns of reduced care intensity under MA contracts, where prior authorization requirements and capped visit allowances can constrain clinically appropriate services and depress quality outcomes. Facilities that systematically document medical necessity, challenge inappropriate denials, and negotiate contract terms that reflect actual care needs are better positioned to protect both patient outcomes and reimbursement under MA.
Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage
Question Are there differences in service intensity and outcomes of home health care between Medicare Advantage and traditional Medicare?
Findings In this cross-sectional study of 178 195 traditional Medicare and 107 102 Medicare Advantage patients, Medicare Advantage patients had shorter home health length of stay by 1.62 days (95% CI, −1.82 to 1.42) and received fewer visits from all disciplines except social work. There were no differences in inpatient transfers. MA patients had 3% and 4% lower adjusted odds of improving in mobility and self-care, respectively (mobility odds ratio [OR], 0.97; 95% CI, 0.94-0.99; self-care OR, 0.96; 95% CI, 0.92-0.99). MA patients were 5% more likely to discharge to the community compared with traditional Medicare.
Meaning MA patients receive fewer home health visits and have worse functional outcomes compared with traditional Medicare.
— JAMA Health Forum, 1 March 2024
Prusynski, R. A., et al. “Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage.” JAMA Health Forum, 1 Mar. 2024. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2815745.
MA’s cost-management tools may be hurting home healthcare quality, outcomes
Medicare Advantage’s use of cost-reducing tools such as copays, prior authorizations and restricted provider networks may be preventing home healthcare providers from delivering higher-quality care… “We’ve seen copays with Medicare Advantage [and] $50 per visit is going to deter people from taking necessary care,” William Dombi, president of the National Association for Home Care & Hospice, said in an interview with McKnight’s Home Care Daily Pulse. “The prior authorization system is going to discourage home health agencies and the attending physician from going to the mat and spending a lot of time, only to get a patient on service who’s going to cost them more money than they’re going to get paid.”
— McKnight’s, 5 March 2024
✔ Comply with every payer's rules
✔ Equip your team with the Playbook
✔ Monitor rates and payer trends
