Traditional Medicare Has Better Home Healthcare Than MA, Study Finds
Medicare Advantage home healthcare agencies offer significantly lower quality care than traditional Medicare plans’ home healthcare agencies, study finds.
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- Medicare Advantage plans are not providing the same high-quality home healthcare to seniors that traditional Medicare does, Brown University researchers discovered.
According to the study, members of traditional Medicare (TM) were 4.9 and 2.8 percent more likely to receive high-quality care than those in a low-rated Medicare Advantage plan and a high-rated Medicare Advantage plan, respectively.
The researchers examined data from over 4.4 million home health admissions using 2015 Outcome and Assessment Information Set (OASIS) admission assessments. The researchers determined home health agency (HHA) quality by looking at the publicly reported patient care star ratings on the Centers for Medicare & Medicaid (CMS) Services Home Health Compare site. Researchers considered HHAs as low-quality when they were rated between 1 and 2.5 stars, average with 3 to 3.5 stars, and high-quality with 4 stars or more.
“The inability to assess the quality of HHAs serving MA beneficiaries is concerning,” the study said. “Although MA plans are required to cover the same minimum healthcare services as TM, MA beneficiaries receive care from their plan’s network of preferred healthcare professionals and organizations, whereas TM beneficiaries may select any Medicare-certified healthcare professional and organization. Thus, similar to what has been observed in the private insurance market, MA plans may form networks with lower-quality HHAs that are willing to accept lower prices.”
TM beneficiaries had a 17 percent chance of receiving low-quality home healthcare and 30.4 percent likelihood of receiving high-quality care.
In contrast, low-rated MA plan beneficiaries had a 20 percent likelihood of receiving low-quality home healthcare and 25.5 percent likelihood of experiencing high-quality care.
In addition to discovering each TM and MA category’s quality of home healthcare, the researchers also identified some key demographic information related to these results.
More than one-third of beneficiaries in low-rated MA plans were non-white (36.5 percent) and dual eligible (43.3 percent),a higher proportion than high-rated MA or TM plans.
When the team controlled for beneficiaries’ zip codes, both low-rated and high-rated MA plans received about the same level of quality in home healthcare.
Geography also played a role in equalizing the three categories, however. All three categories of plans were more likely to offer low-quality home healthcare the farther they were from a high-quality HHA.
The researchers concluded that the MA plans may be suffering because of their smaller, less expensive home health networks. The study also pointed to the low-quality skilled nursing facilities which MA plans employ as a possible factor in the discrepancies.
The study also noted that HHA quality is not considered in MA plan quality ratings.
CMS should revisit the MA plan quality ratings criteria to consider including an HHA quality assessment, the researchers said. Members should be more well-educated about their post-acute home healthcare options and their hospital discharge processes need to change, the study recommended.
“The present study results indicated that compared with their TM counterparts, MA beneficiaries received treatment from lower-quality HHAs. Policy makers may consider incentivizing MA plans to include higher-quality HHAs in their preferred HHA networks and improving patient education regarding HHA quality,” the study suggested.
These concluding recommendations do not fall on a deaf audience. The subject of long-term care and home health services continues to draw policymakers’ attention as Baby Boomers enter into retirement. Private payers have offered their opinion on Congress’s intended long-term care insurance reform, including measures to make it possible for members to remain in their homes.
With the new budgetary restrictions imposed by CMS, bolstering home healthcare may seem like an attractive, cost-effective solution to MA plans. In 2017, an AARP study found that nursing homes could cost over three times the price of a home health aide.
However, if MA plans are not offering high-quality home healthcare, then the savings could become expenditures for the bigger health issues that result from poor care.
