The Medicare Payment Advisory Commission’s (MedPAC) June report to Congress examined home health care use among Medicare Advantage (MA) and traditional Medicare patients and found that MA enrollees receive 11% fewer home health visits compared to Medicare fee-for-service.
The report, issued Thursday, largely found “relatively modest” differences in home health use between MA and Medicare fee-for-service beneficiaries, though it found that prior year hospitalization, the type of MA plan and other factors impacted utilization.
MedPac stated that previous studies have been too limited to draw nationally representative conclusions. The report concluded that the overall rate of home health use is slightly lower among MA enrollees than in fee-for-service beneficiaries. Among MA enrollees, 8.3% used home health services while 8.6% of fee-for-service beneficiaries did so, though rates differed if patients were hospitalized within the year.
Among those who had been hospitalized, the probability of home health care use was 3.2% higher among MA enrollees than fee-for-service beneficiaries. This increase “could suggest that home health care is sometimes used in MA as a substitute for other types of post-acute care, such as costlier SNF stays,” according to the report.
Regardless of whether a patient had been hospitalized in the last year, MA enrollment was associated with an average of 11% fewer visits per beneficiary compared to Medicare fee-for-service. Even within the same home health agency, MA beneficiaries are likely to receive fewer home health visits, according to the report.
Home health care utilization differed among MA enrollees depending on the type of plan. Plans with home health cost sharing were associated with lower rates of home health care use as well as a lower average number of visits.
Preferred provider organization plan enrollees were likely to have a higher number of visits, but were just as likely to utilize home health care as HMO plans.
“We emphasize that it is not possible to draw conclusions on the appropriateness of care based solely on observing differences in use (and most of the differences we observed are relatively modest),” the report read. “Home health care is one component of the broader [post-accute care] (PAC) landscape, and its use is likely affected by the availability of other PAC providers, as well as other factors such as types of MA plans, their provider networks, the supplemental benefits they offer and the prior hospitalization (if there is one).”
The report also found that skilled nursing and physical therapy were the most common types of visits among both traditional Medicare and MA home health users.
Among MA enrollees, those using home health for wound care received the most visits, with an average of 25.1 visits per beneficiary, while the fewest visits were among patients using home health care for medication management, teaching, and assessment (MMTA) surgical aftercare, with 14.5 visits per beneficiary.
The June report comes two months after MedPAC recommended that Congress reduce Medicare fee-for-service home health payments by 7%, the same rate cut MedPAC advised in 2024.
“Our review indicates that FFS Medicare payments for home health care are substantially in excess of costs,” MedPAC stated in the March report. “Home health care can be a high-value benefit when it is delivered efficiently and appropriately, but these excess payments undermine that value.”
