While MA Penetration Grows, Plans Continue to Underpay Providers, Home Care Advocates Say
McKnight’s Home Care | By Adam Healy
As Medicare Advantage continues to dominate total Medicare enrollment, home care providers face mounting reimbursement challenges and improper service denials that constrain their ability to care for patients, they argue.
On Tuesday, healthcare research and advisory services firm ATI Advisory released its 2024 Medicare Advantage Enrollment Databook, an up-to-date snapshot of the Medicare enrollment landscape. It found that MA penetration has tipped above 50% in more than half of the states in the United States, and private plans’ membership growth has shown no signs of stopping.
While MA enrollment increases, the number of Medicare fee-for-service beneficiaries has actually been on the decline, according to the report. MA enrollment grew at an annual rate of roughly 7% in the past year, adding about 2.2 million new members between 2023 and 2024. During the same period, traditional Medicare lost about 2% of its population, or roughly 700,000 members.
As many as 10 million new members are projected to join MA plans by 2031, which would put MA penetration closer to 55%, according to the report.
Meanwhile, home healthcare stakeholders have been raising concerns that MA plans’ cost-management strategies and stingy reimbursement rates have hindered patients’ access to quality care. Just last week, LeadingAge representatives sent a letter to Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure pointing out some of these very concerns.
“MA plan contracted rates with SNFs (skilled nursing facilities) and HHAs (home health agencies) have been, at best, 60-80% of what these providers would have been paid under traditional Medicare,” Nicole Fallon, vice president of integrated services and managed care at LeadingAge, wrote in the letter. “In addition to plans paying providers inadequately, MA plans have added layers of administrative burden onto these providers … In other words, providers are being asked to do more and being paid less.”
Many home healthcare providers have had to hire additional staff to handle administrative burdens such as prior authorization requests or unintuitive MA claims processes, Fallon roted. And though Medicare-eligible patients are increasingly aligning themselves with MA plans, MA’s flaws ultimately reduce their access to good home healthcare.
“Arguably, some MA plans are not delivering on the basic requirements today of ensuring beneficiaries have access to core Medicare A and B services,” Fallon wrote. “While the MA program offers benefits above traditional Medicare … the cost of inadequate provider payments and improper care denials and terminations for beneficiaries is proving to be too high a trade-off.”
In a McKnight’s Newsmakers podcast last month, Fallon and Mollie Gurian, VP of home-based public policy for LeadingAge, talked about how CMS must continue to challenge MA plans to narrow prior authorization decision-making times, improve access and ensure fair payment adequacy to providers. |
How Beneficiaries Really Feel About Medicare Advantage vs Traditional Medicare
MedPage Today | By Cheryl Clark
Survey results released today contradict widely-held beliefs that Medicare Advantage enrollees are more satisfied because they receive better health services than those in traditional Medicare.
On the contrary, respondents in the two types of Medicare plans reported equal satisfaction, although more Medicare Advantage (MA) enrollees than traditional Medicare (TM) beneficiaries said their care was delayed because of the need for prior approval.
The reportopens in a new tab or window by The Commonwealth Fund analyzed responses from 3,280 Medicare beneficiaries between November 6, 2023, and January 4 in an effort to learn "What Do Medicare Beneficiaries Value About their Coverage?" Those surveyed gave their opinions on the ease of their access to benefits, care coordination, services, and satisfaction.
"Overall, the experiences seem to be similar for those in traditional Medicare versus Medicare Advantage, with some notable exceptions," Gretchen Jacobson, PhD, vice president of Commonwealth's Medicare program, told MedPage Today.
The comparison of beneficiary experiences in each model is important because roughly half, or 52% of 66 million eligible people, are now enrolled in MA plans, to which federal funds pay billions more than for TM care. In 2024, for example, MA plans are expected to receive $88 billionopens in a new tab or window more than what would have been spent if the same people were in TM.
Although there are efforts underway to contain that spending through new payment policiesopens in a new tab or window, MA enrollment is projected to continue rapid growth. So it's important that taxpayers understand what they're getting for all that extra money.
A perhaps surprising finding of the survey was MA enrollees' relatively low use of their "extra benefits," such as vision, hearing, and dental care, considering that plans aggressively market these benefits to encourage signups. Jacobson noted that Medicare pays the plans $1,915 a year per enrollee for these benefits, according to the 2023 annual reportopens in a new tab or window from the Medicare trust funds' trustees. These extras are not covered under TM…
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Meet the 2024 APTA Home Health Award Recipients
The following recipients were nominated by various members of the Academy, and were selected based on the outlined criteria below by the executive committee of APTA Home Health. These Home Health Awards were presented to recipients at the APTA Home Health business meeting on Friday, February 16, 2024.
To view award details and recipient bios, please click here.
President's Award
- Dr. Eva Norman, PT, DPT, CEEAA
Excellence in Home Health Leadership Award
- Dr. Denise Wagner, PT, DPT
- Dr. Betsy Coyle, PT, DPT
- Dr. Paras Goel, PT, DPT, MED
Excellence in Home Health Clinical Practice Award
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Click here to listen to Episode 1! |
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