Patients on Medicare Advantage Receive Shorter, Less Intensive Home Health Care

Patient outcomes when using home health care services were different depending on whether the patient used Medicare Advantage (MA) or traditional Medicare (TM), according to a study published in JAMA Health Forum. The study found that this extended to patients who had similar needs from their health services.

Patients who are homebound and on Medicare can request home health care services as long as their clinician identifies the need, which includes rehabilitation, home health aides, and nursing. MA plans are being used by private insurers to provide these home health care services, with the enrollment in MA surpassing that of TM. Patients on TM are certified for 60-day home health episodes but patients on MA have shorter home health stays. Patients with MA can also receive care from lower-quality agencies. Administrative data from a national health care network was used for this study to evaluate the gaps in care between TM and MA when it came to home health care.

Medicare Advantage | Image credit: NajmiArif - stock.adobe.com

Data from 102 locations in 19 states were collected from a national nonprofit home health company. Data from January 2019 through December 2022 about admission and discharge assessments were used. Patients who were aged 65 years and older and had 2 or fewer 60-day certification episodes were considered for this study. Patients seen for intermittent maintenance care were excluded.

Length of stay (LOS) and number of visits were used as home health intensity outcomes. LOS was defined as the number of days between the start and discharge of home health. The number of visits could include visits from nursing, physical therapy, speech therapy, home health aides, social work, and occupational therapy. Demographic characteristics were collected from all patients, with race and ethnicity being self-reported. Level of cognitive impairment was included along with whether home health was provided in an institution or a community setting.

There were 178,195 patients with TM and 107,102 patients with MA included in this study. Patients with MA were younger, more likely to identify as male and non-Hispanic White, and were more likely admitted from the hospital compared with patients with TM. Patients on MA were less impaired in self-care and mobility at admission, had lower rates of cognitive impairment, and had lower overall medical risk.

Patients with MA had a 1.62 day (95% CI, –1.82 to –1.42) shorter mean home health LOS. Patients with MA also received 4.9% fewer nursing visits, 2.7% fewer physical therapy visits, 2.9% fewer occupational therapy visits, 5% fewer home health aide visits, and 5.0% fewer speech therapy visits. Mobility function and self-care function were 3% (OR, 0.96; 95% CI, 0.94-0.99) and 4% (OR, 0.97; 95% CI, 0.92-0.99) less likely in patients with MA, respectively. Being discharged to the community was also 5% less likely in patients with MA (OR, 1.05; 95% CI, 1.01-1.08) compared with patients with TM.

There were some limitations to this study. Differences in MA plans were not accounted for in the analysis. Data from inpatient stays were not available. Assessments had the potential to be incomplete. The researchers were unable to link an improvement in function to quality of life or independence. All data came from 1 nonprofit company, which may not make the data generalizable to companies that are for profit.

The researchers concluded that patients on MA had a shorter LOS for home health, had fewer visits by their home health, and had lower rates of improving self-care. Independence and caregiver burden in patients with MA could be influenced by these results.

Reference

Prusynski RA, D’Alonzo A, Johnson MP, Mroz TM, Leland NE. Differences in home health services and outcomes between traditional Medicare and Medicare Advantage. JAMA Health Forum. Published online March 1, 2024. doi:10.1001/jamahealthforum.2023.5454