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“Medicare Advantage Enrollees More Likely to Enter Lower-Quality Nursing Homes Compared to Fee-For-Service Enrollees,” a report recently published by Health Affairs, examines the quality of skilled nursing facilities (SNFs) used by Medicare Advantage (MA) enrollees and traditional Medicare beneficiaries. As the title indicates, the authors of the report found that traditional Medicare beneficiaries “tended to use higher-quality SNFs” than their MA counterparts during the study period (2012-2014).[1]

The authors note that MA enrollees “entered SNFs with significantly higher rehospitalization rates compared” to traditional Medicare beneficiaries.[2] Not surprisingly, the report underscores research indicating that MA enrollees “move from Medicare Advantage to FFS [Fee-for-service, or traditional Medicare] in higher numbers after a SNF stay.”[3] Additionally, the report finds that traditional Medicare beneficiaries “may be influenced more by publically available measures of quality, while MA enrollees might be limited by SNF networks established by MA plans.”[4] 

Although private insurers advertise MA plans as providing enrollees with greater flexibility at lower cost, this study indicates that MA network limitations may impede access to high-quality SNF care.[5] This finding comports with what the Center for Medicare Advocacy often hears from Medicare beneficiaries – that MA plans can become a barrier to care when an enrollee needs more intensive care or the services of a specific out-of-network provider.

The authors conclude that the Centers for Medicare & Medicaid Services (CMS) could better serve Medicare beneficiaries by requiring “MA plans to be more transparent about the quality of SNFs in their networks when beneficiaries make their [annual] Medicare enrollment decisions.”[6]

D. Valanejad, January 24, 2018

 

 


[1] David J. Meyers et. al., Medicare Advantage Enrollees More Likely to Enter Lower-Quality Nursing Homes Compared to Fee-For-Service Enrollees, Health Affairs (Jan. 2018), https://doi.org/10.1377/hlthaff.2017.0714.
[2] Id.

[3] Id.
[4] Id.
[5] See id. (“Enrollees in both lower and higher-quality MA plans were admitted to SNFs that had significantly lower overall star ratings and significantly higher adjusted rehospitalization rates . . . We hypothesize that several factors may have led to these findings. FFS [Traditional Medicare] enrollees are not limited by network design when selecting a SNF.”).
[6] Id.

 

 

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