A June report from the Medicare Payment Advisory Committee to Congress (MEDPAC) examined the use of home health care between Medicare Advantage (MA) and traditional Medicare patients, finding MA enrollees receive 11% less home visits compared to Medicare fees.
The report, published Thursday, found mostly “relatively modest” differences in home health care use between MA and Medicare service fee beneficiaries, but found that prior year hospitalizations, MA plan types, and other factors influenced utilization.
MEDPAC said previous studies were too limited to draw nationally representative conclusions. The report concluded that overall in-home health utilization was slightly lower for MA subscribers than for service fee beneficiaries. Of MA enrollees, 8.3% used home health services, and 8.6% of beneficiaries of service fees did so, but the fees differed if patients were hospitalized within one year.
Among those hospitalized, the likelihood of using home care was 3.2% higher among MA enrollees than beneficiaries of service fees. The increase, according to the report, “suggests that home care will be used in MA as an alternative to other types of acute care, such as expensive SNF stays.”
Regardless of whether patients were hospitalized last year, MA enrollment was associated with an average of 11% less visits per beneficiary compared to Medicare fees. The report says that even within the same home healthcare institution, MA beneficiaries are more likely to receive home visits.
Home care use differed between MA enrollees, depending on the type of plan. Planning with home health care costs was associated with low home health care use as well as low average visits.
Registrants with the Priority Provider Organizational Plan are likely to make more visits, but are likely to use home care as much as HMO plans.
“We emphasize that we cannot draw conclusions about 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 care is one element of the broader (post acccute post-care) (PAC) landscape, and its use can be influenced by the availability of other PAC providers and other factors such as the type of MA plan, provider network, supplemental benefits offered, and previous hospitalizations (one).”
The report also found that skilled nursing and physical therapy are the most common type of visits in both traditional Medicare and home health users in MA.
Among MA enrollees, those using home hygiene for wound care received the most visits with an average of 25.1 visits per beneficiary, while the fewest visits used home health care (MMTA) aftercare for drug management, education, and assessment (MMTA) surgical aftercare.
The June report comes two months after MEDPAC recommended that Congress cut home health costs in Medicare fees by 7%.
“Our review shows that Medicare payments for FFS home healthcare are significantly exceeding costs,” MedPac said in its March report. “Home care can be a valuable benefit when it is delivered efficiently and properly, but these overpayments undermine that value.”
