In a recent study published in the JAMA Health Forum, it was discovered that beneficiaries of Medicare Advantage receive less comprehensive home healthcare services compared to those enrolled in traditional Medicare. This significant research sheds light on the differences in care intensity and patient outcomes within these two segments of the Medicare program.
Home healthcare, a crucial service for many, includes a range of services such as nursing, rehabilitation, assistance from home health aides, and medical social work. These services are not just medical interventions but are pivotal in enhancing patient quality of life, reducing hospital readmissions, and even lowering mortality rates.
The study points out that traditional Medicare offers a 60-day certification for home health episodes, with agencies receiving reimbursement per 30-day periods. This payment structure takes into account various factors including patient characteristics and the source of admission. On the other hand, Medicare Advantage plans, which are an alternative to traditional Medicare provided through private insurers, often impose additional steps like prior authorization or recertifications for home healthcare services.
Researchers delved into the administrative records of a large national non-profit home health organization, analyzing the care received by 107,102 Medicare Advantage beneficiaries versus 178,195 traditional Medicare beneficiaries from 2019 to 2022. The findings revealed that those under Medicare Advantage were generally younger, more likely to have been admitted from a hospital, and had lower medical risk. They also tended to have less impairment at the start of their care, were more likely to live alone, and resided in more rural or socioeconomically disadvantaged areas.
The analysis showed that Medicare Advantage beneficiaries experienced a notably shorter average length of stay in home health care by approximately 1.62 days or 3.5 percent less than their traditional Medicare counterparts. This group also received fewer visits from nurses, physical therapists, occupational therapists, speech therapists, and home health aides.
Moreover, the study highlighted that Medicare Advantage beneficiaries had a lower likelihood of improving in mobility and self-care, yet they had a higher probability of being discharged to the community. This juxtaposition raises concerns about the potential for increased caregiver burden and negative health outcomes, especially for those beneficiaries who live alone.
The findings call for a critical evaluation of the policies and programs that may be discouraging the utilization of home healthcare services within the Medicare Advantage plans. Ensuring that such evaluations consider the impact on functional outcomes is essential for future healthcare planning and policy development.