For skilled nursing facilities, these findings underscore the real patient harm created when MA cost-control mechanisms and care coordination gaps prevent beneficiaries from receiving ordered post-acute services.
Unfulfilled Home Health Referrals Lead to Higher Mortality Among Medicare Advantage Members
Medicare Advantage members referred to home health after acute hospitalization who did not receive home health services had higher mortality at 30, 90, and 180 days.
Objectives: Medicare Advantage (MA) members referred to home health after inpatient hospitalization may or may not receive these services for a variety of member- and health care system–related reasons. Our objective was to compare outcomes among MA members referred to home health following hospitalization who receive home health services vs those who do not.
Because referring hospital physicians believe that their members will receive home health and may plan their discharges accordingly, it is highly important to address gaps in understanding, anticipate barriers to service, and strengthen communication between inpatient teams and home health agencies.
— The American Journal of Managed Care, 9 July 2024
Gada, Elan, et al. “Unfulfilled Home Health Referrals Lead to Higher Mortality Among Medicare Advantage Members.” The American Journal of Managed Care, 9 Jul. 2024. https://www.ajmc.com/view/unfulfilled-home-health-referrals-lead-to-higher-mortality-among-medicare-advantage-members.
UnitedHealth Study: Is Medicare Advantage Killing Seniors
Dr. Landers points readers toward a study conducted by Dr. Elan Gada of UnitedHealthcare’s Optum Group. The results are disturbing. That the findings were released by a Medicare Advantage company is surprising.
— The Rowan Report, 25 October 2024
Unfulfilled MA referrals for home healthcare can lead to ‘grave consequences,’ study finds
Medicare Advantage patients who are referred to but never receive home health services experience higher mortality rates and lower readmissions compared to those who received such services… The researchers examined 2,876 acute hospital discharges occurring between January 2021 and October 2022 that included home health referrals. Of these, 2,115 referrals led to the patients receiving home healthcare. The remaining 761 referrals did not lead to home health visits.
— McKnight’s Home Care, 16 July 2024
✔ Comply with every payer's rules
✔ Equip your team with the Playbook
✔ Monitor rates and payer trends
