Fewer Medicare Advantage enrollees report using post-acute care services than traditional Medicare beneficiaries. But even when they do use them, a new study finds that those MA patients report more undesirable outcomes.
Researchers at Vanderbilt University surveyed nearly 2,400 Medicare beneficiaries who had used skilled nursing, an institutional rehab facility or home care after surgery or hospital-related care.
They found that MA enrollees had shorter duration of services versus traditional Medicare patients. The MA patients also reported less functional improvement while receiving services. Among respondents with a self-reported hospitalization; fall; hip or knee surgery in the past year; arthritis; or osteoporosis, the MA enrollees reported both negative outcomes: They used less post-acute care and had less functional improvement.
Previous research based only on administrative data had found that reduced use of post-acute services did not degrade outcomes such as readmissions, successful discharge to community or mortality.
“Understanding how beneficiaries perceive the implications of post-acute care services for functional outcomes is important, particularly since other studies have largely used only administrative data sources,” the researchers wrote in a JAMA Health Forum study published Friday.
“Findings of the present study suggest that self-reported data from Medicare beneficiaries may introduce important evidence about potential declines in patient satisfaction that should be investigated as Medicare seeks to expand payment models that promote more efficient use of post-acute care services,” added the team of Vanderbilt professors Laura M. Keohane and David G. Stevenson and PhD candidate Emma M. Achol. “Examining self-reported patient outcomes is key to ensuring that the MA program adequately meets beneficiaries’ needs, particularly since there is evidence that MA enrollees are treated at lower-quality SNFs.”
The team noted recent research regarding an MA connection to lower-quality SNFs, possibly due to the type of practitioners available in MA networks. They also pointed to MA plans’ frequent use of prior authorization as a tactic that could undercut patient care. Such plan behavior “may delay patients’ receipt of these services or end such services before the beneficiary is ready, which could be associated with higher levels of dissatisfaction with care,” they wrote.
Skilled nursing providers have been highly critical of such tactics, and they also have been the focus of several recent Congressional hearings.
The researchers emphasized the importance of policymakers reviewing broader evidence before committing more fully to value-based care plans and programs that encourage strict utilization management practices.
“Several Medicare payment models in addition to MA have targeted reducing unnecessary use of post-acute care services,” they wrote. “According to evaluations of administrative data, the Medicare Shared Savings Program and mandatory bundled payments achieved savings by decreasing post-acute care use without adverse outcomes. However, findings of the present study suggest that self-reported data from Medicare beneficiaries may introduce important evidence about potential declines in patient satisfaction that should be investigated as Medicare seeks to expand payment models that promote more efficient use of post-acute care services.”
