Home Health Disparities: Medicare Advantage Patients Receive Fewer Visits, Worse Outcomes

Home health patients under Medicare Advantage (MA) plans have worse functional outcomes compared to traditional Medicare patients, likely as a result of receiving fewer visits, according to a new study.

The new study is from researchers with the Department of Rehabilitation Medicine at University of Washington.

“The primary message of this study is that Medicare Advantage patients receive fewer home health visits and have worse functional outcomes than their traditional Medicare counterparts,” Rachel Prusynski, a professor at the University of Washington School of Medicine, said in an email to Home Health Care News. “They’re also more likely to discharge to the community after home health, but combined with less functional improvement, we’re worried that this may have negative implications for independence in the community or potentially higher caregiver burden.”


In the study — which included nearly 300,000 patients — MA patients had shorter home health length of stay by 1.62 days and had 3% and 4% lower adjusted odds of improving in mobility and self-care, respectively. The results of the study suggest that MA patients receive shorter and less intensive home health care versus traditional Medicare patients with similar needs, the authors wrote.

The University of Washington study was conducted from Jan. 2019 to Dec. 2022 in 102 home health locations in 19 states.

Those differences may be caused by increased administrative burden and the cost-limiting incentives of MA plans, the study authors wrote.


Researchers also found that MA patients were more likely to improve in function and discharge to the community and less likely to transfer to an inpatient facility during their home health stay before adjustment.

MA patients not only received a 3.5% shorter length-of-stay, but they also received statistically significantly fewer visits from every discipline except for social work. Compared with traditional Medicare averages, these differences resulted in MA patients receiving 4.9% fewer nursing visits, 2.7% fewer physical therapy visits, 2.9% fewer occupational therapy visits, 5% fewer speech therapy visits, and 5% fewer home health aide visits.

Source: Department of Rehabilitation Medicine at University of Washington

Traditional Medicare covers over 58 million beneficiaries on an annual basis, costing nearly $17 billion in 2021. Private insurers — particular Medicare Advantage plans — have been taking up much more of the pie in recent years, and crossed the 50% threshold in 2023, meaning more beneficiaries are covered by MA plans than traditional Medicare.

While MA plans some additional benefits, they often employ cost-cutting measures like copays and prior authorization. Medicare pays MA plans a capitated rate per beneficiary to cover enrollee health needs. That dynamic incentivizes MA plans to coordinate care and reduce costs, some believe.

However, this disparity has led to some concerns about the levels of access to care within MA plans.

“MA plans have more flexibility in limiting costs by requiring prior authorization or frequent recertifications, constraining the number of visits, or limiting the length of the home health stay,” Prusynski wrote. “Compared with traditional Medicare, MA beneficiaries have less frequent home health utilization and shorter home health stays — even when home health is prescribed at hospital discharge.”

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