MedPAC: Lower MA Home Health Utilization Sparks Access Vs. Efficiency Debate

Medicare Advantage (MA) beneficiaries used fewer home health services than their fee-for-service counterparts in 2023, prompting Medicare Payment Advisory Commission (MedPAC) commissioners to ask whether MA plans are limiting access to necessary post-acute care.

For beneficiaries who used home health, MA enrollees had 12 annual home health visit-days compared with 15 visit-days for fee-for-service beneficiaries, according to a preliminary analysis from MedPAC.

“It’s so easy to think, ‘Oh my, these rates are so different; MA must be stinting on care, not getting people the post-acute care they need.’ And indeed there are lots of anecdotes out there about that,” MedPAC Commissioner Tamara Konetzka said in a Sept. 4 meeting. “At the same time, … we realize the margins in fee-for-service post-acute care are incredibly high.”

Comparing MA and traditional Medicare data offers an opportunity to determine whether plans restrict access to care or whether Medicare fee-for-service has overpays for unnecessary services, Konetzka said.

“The MA versus fee-for-service comparison here is just really exciting,” Konetzka said.

Among beneficiaries who used SNF care, MA enrollees had a median of 20 SNF days in 2023, compared with 33 days for FFS beneficiaries, MedPAC’s analysis found. The longer SNF stays could reflect differences in benefit design or patient complexity, another commissioner said.

For its analysis, MedPAC reviewed a sample of 25.6 million fee-for-service beneficiaries and 27.8 million Medicare Advantage enrollees. Post-acute care and acute care hospital data sources were derived from fee-for-service claims, MA encounters and patient assessment data for post-acute care settings.

“Medicare does not cover long-term care services supports in the home,” MedPAC Commissioner Gina Upchurch said. “It supports improving, maintaining, or compensating for lost [function] for a short period of time.”

However, MedPAC notes that the data is preliminary and does not adjust for risk factors such as dual eligibility, disability and age. Additionally, the organization flagged concerns from the Office of Inspector General (OIG) that Medicare Advantage prior authorizations can delay or deny post-acute care.

Therefore, individuals should take MedPAC’s data with caution, said MedPAC Commissioner Brian Miller. In addition, Miller noted that viewers should not equate home health with other post-acute care services.

“When we try and merge home health as an equivalency to SNF, IRF, and long-term care, we are completely ignoring the underlying critical aspect and uniqueness of the original legislation and the design of this benefit,” Miller said.

Established in 1997, MedPAC is an independent, nonpartisan congressional agency that advises legislators on Medicare quality of care, patient access and other issues.

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