By Lisa Rapaport
(Reuters Health) – Older Americans who get home healthcare through traditional Medicare plans may have access to better quality services than their counterparts who enroll in private plans known as Medicare Advantage, a U.S. study suggests.
To examine home health agency quality by insurance type, researchers analyzed data on almost 4.4 million home health admissions for Medicare beneficiaries in 2015.
Three quarters of the study population had traditional Medicare coverage, while about 17% were in high-quality Medicare Advantage plans based on Medicare’s own five-star rating system and 8% were in low-quality Medicare Advantage plans.
Overall, 17% of traditional Medicare members received care from low-quality home health agencies, compared with 23.5% of people in low-quality Medicare Advantage plans and 18.3% of those in high-quality Medicare Advantage plans.
More Medicare Advantage members may end up with low-quality home health agencies because they can only use agencies that are covered as part of their insurance network, said Margot Schwartz, a researcher at Brown University in Providence, Rhode Island, who led the study.
“Traditional Medicare beneficiaries are able to select and receive care from any Medicare-certified home health agency,” Schwartz said by email. “The limited networks in Medicare Advantage may result in these beneficiaries receiving care from lower-quality home health agencies.”
Some higher-quality home health agencies may also opt not to participate in Medicare Advantage plans because of low reimbursement rates, said Momotazur Rahman, also at Brown University and the study’s senior author.
“Payment rates by Medicare Advantage plans to home health agencies are much lower compared to traditional Medicare payment rates,” Rahman said by email. “This may drive highly-rated home health agencies away from the Medicare Advantage patients.”
The disparity in home health agency quality may impact a growing number of Americans because enrollment in Medicare Advantage plans is on the rise.
The proportion of Medicare members enrolled in Medicare Advantage increased from 13% in 2004 to 33% in 2017, researchers note in JAMA Network Open.
Roughly half of the Medicare beneficiaries who receive home health care services are over 75 years old, and they are all homebound because of severe illness or functional limitations that may be exacerbated by low-quality care, the study team notes.
People in the study who enrolled in low-quality Medicare Advantage plans were more likely to be nonwhite and poor.
Patients with traditional Medicare were also more likely to receive care from home health agencies with the highest quality marks. About 30% of traditional Medicare members received care from top-quality home health agencies, compared with 27% of patients with high-quality Medicare Advantage plans and 23% of people with low-quality Medicare Advantage plans.
The study wasn’t designed to prove whether or how the type of Medicare coverage people had directly impacted the quality of home health care they received, and it also didn’t assess any resulting health outcomes.
Medicare rates home health agencies on a scale of one to five stars, with scores below 3 stars indicating low quality and above 3.5 stars indicating better quality (https://bit.ly/2m225jK).
Medicare also ranks Medicare Advantage plans by zip code with a five-star rating system.
SOURCE: https://bit.ly/2lUKx91 JAMA Network Open, online September 4, 2019.