November 28th, 2018
A new study has found that people enrolled in
a Medicare Advantage plan were more likely to enter a lower-quality nursing
home than were people in traditional Medicare. The study raises questions about
whether Medicare Advantage plans are influencing beneficiaries' decisionmaking
when it comes to choosing a nursing home.
Medicare Advantage plans, an alternative to
traditional Medicare, are provided by private insurers rather than the federal
government. The government pays Medicare Advantage plans a fixed monthly fee to
provide services to each Medicare beneficiary under their care, and the
services must at least be equal to regular Medicare’s. While the plans
sometimes offer benefits that original Medicare does not, the plans usually
only cover care provided by doctors in their network or charge higher rates for
out-of-network care.
The study, conducted by researchers at Brown
University School of Public Health, examined Medicare beneficiaries entering
nursing homes between 2012 and 2014. Using Medicare’s
Nursing Home Compare website as the measure of quality, the
study found that beneficiaries in Medicare Advantage plans tended to enter
lower quality nursing homes than beneficiaries in original Medicare. This was
true even when the researchers took into account the beneficiaries' distance
from the nursing home and other decision factors. Even beneficiaries enrolled
in highly rated Medicare Advantage plans were more likely to enter a
low-quality nursing home compared to original Medicare beneficiaries.
The study does not draw any conclusions about
whether the Medicare Advantage beneficiaries fared worse than original Medicare
beneficiaries, only that they tended to enter facilities that had higher
re-hospitalization rates and worse outcomes. The study concluded that Medicare
Advantage plans may be influencing beneficiary decisionmaking around nursing
home selection. According to Skilled Nursing News, one of the
study’s authors speculated that a Medicare Advantage plan "might be
incentivized to send patients to a given nursing home regardless of what the
quality ratings are, because of a relationship with that nursing home or
because they have a lot of patients in that nursing home and can better manage
their care."
Information on exactly why this is happening
is “of vital policy importance,” according to the study's authors. They
recommend gathering more information about Medicare Advantage nursing home
claims and re-hospitalization rates and requiring Medicare Advantage plans to
be more transparent about the quality of nursing homes in their networks.
To read the study, which was also published in
the January issue of the journal Health Affairs, click here.
For more information about Medicare
Advantage, click here.
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