Ronnie Cohen JANUARY 26, 2018
(Reuters Health) -
Medicare Advantage plans might prove to be a disadvantage for U.S. enrollees in
need of skilled nursing care, a new study suggests.
Traditional Medicare
enrollees were more likely to enter higher-quality skilled nursing facilities
than Medicare Advantage enrollees, the study found. The differences were small
but significant and persisted even after researchers adjusted for distance and
other factors.
“If you enroll in
Medicare Advantage, then you might not have as good an option in a nursing
home,” said lead author David J. Meyers, a doctoral student in health services
research at Brown University in Providence, Rhode Island.
“If it’s important to
have access to the best nursing homes, fee-for-service Medicare might be the
option for you,” he said in a phone interview.
Americans age 65 or
older choose between traditional fee-for-service Medicare, a public health
insurance program, and Medicare Advantage programs – commercial insurance plans
touted as offering comprehensive disease management and care coordination to
help seniors manage health conditions.
During the past
decade, enrollment in Medicare Advantage has steadily increased to 31 percent
in 2016, the authors write in Health Affairs.
Meyers and his team
analyzed all Medicare enrollees age 65 or older who were admitted to a skilled
nursing home between 2012 and 2014 and had not been in one the previous year.
Across most ZIP codes,
they found that traditional Medicare beneficiaries tended to go to facilities
deemed higher quality in a five-star government rating system. The star ratings
are based upon safety inspections, patient surveys and patient outcomes, such
as whether they returned to the hospital, Meyers said.
(Medicare nursing home
ratings are available online at bit.ly/2GhedTA.)
The findings were to
be expected, said Yue Li, a health policy professor at the University of
Rochester Medical Center in New York. But Li, who was not involved with the
study, categorized the differences as “very tiny.”
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Almost 55 percent of traditional
Medicare patients went to skilled nursing facilities that the federal Centers
for Medicare and Medicaid Services ranked four or five stars, compared to 50
percent of lower-quality Medicare Advantage enrollees and 52 percent of
higher-quality Medicare Advantage enrollees, researchers found.
“One might assume that
if you pay more for a Medicare Advantage plan, you get better care, but that
might not be true,” Meyers said.
Meyers and Li both
hypothesized that the study findings could be a result of Medicare Advantage
offering fewer choices of skilled nursing facilities than traditional Medicare.
“It seems like these
fewer choices Medicare Advantage plans offer might not be as high quality,”
Meyers said.
Medicare Advantage
plans generally tend to cost more, though they also may offer appealing benefits,
like gym memberships, he said. Nonetheless, enrollees who need skilled nursing
may be surprised to find themselves with limited options.
The study was unable
to examine copays billed to Medicare Advantage patients who spent time in
skilled nursing facilities.
“Usually, when we
decide to enroll in a plan, we consider physicians, hospitals,” Li said. “I
wouldn’t expect the quality in skilled nursing facilities would affect the
decision-making.”
Once Medicare
Advantage patients experience health crises requiring expensive care like
skilled nursing, Meyers said he suspects they might switch to traditional
Medicare. Medicare beneficiaries can change plans annually during
open-enrollment periods.
In spite of financial
incentives for Medicare Advantage plans to prevent unnecessary hospital
admissions, previous research shows mixed results when comparing the two
programs’ readmission rates.
A previous recent
study found that Medicare Advantage plans appear to disadvantage
African-Americans. Blacks covered under private Medicare Advantage plans were
64 percent more likely than whites to be readmitted to hospitals within a month
of surgery, the study found.
SOURCE: bit.ly/2G6hYuT Health
Affairs, online January 8, 2018.
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