Changes in home health care use in Medicare Advantage compared to traditional Medicare: 2011--2016
- Collection:
- Health Policy and Services Research
- Author(s):
- Zuckerman, Stephen, author Skopec, Laura, author Aarons, Joshua, author Berenson, Robert A., author Feder, Judith, author Wissoker, Douglas, author Huckfeldt, Peter J., author
- Contributor(s):
- United States. Department of Health and Human Services. Office of the Assistant Secretary for Planning and Evaluation. Office of Behavioral Health, Disability, and Aging Policy, issuing body.
- Publication:
- [Washington, D.C.] : United States Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Behavioral Health, Disability, and Aging Policy, September 2020
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Facilities and Services Utilization Home Care Services Medicare Medicare Part C United States
- Genre(s):
- Technical Report
- Abstract:
- Medicare beneficiaries who need intermittent skilled care to treat their illnesses or injuries and cannot leave their homes without considerable effort are eligible for home health care benefits. In 2015, 12,346 home health agencies (HHAs) served 3.5 million Medicare enrollees, and these services accounted for approximately 5 percent of traditional Medicare spending. Unlike many other Medicare benefits, the home health benefit in traditional Medicare is not subject to cost-sharing or deductibles, and there is no limit on the number of home health visits or episodes a Medicare beneficiary can receive as long as he or she meets the eligibility requirements. Home health services are frequently used after a hospital stay to treat an acute health condition. However, the Medicare Payment Advisory Commission (MedPAC) has expressed concern about growth in admissions to home health directly from the community, suggesting these admissions may be substituting for long-term care benefits that are not covered by the Medicare program. In traditional Medicare, home health care providers receive a prospective payment for a 60-day episode of care, and payments are adjusted for patients' clinical and functional characteristics as well as the number of therapy visits provided. Prior work has shown that home health providers strategically provide therapy visits and recertify episodes in order to maximize payment under this system, which may not be the most efficient or clinically effective use of home health services. In contrast, Medicare Advantage (MA) have more flexibility in terms of how they pay for home health care. Medicare Advantage plans receive a monthly capitated rate from Medicare for each enrollee and thus have financial incentives to use home health care strategically and efficiently, and potentially to substitute home health for more intensive services. Moreover, Medicare Advantage plans have flexibility to define a network of HHAs, apply cost-sharing to home health benefits, and manage utilization of home health services. Little research has been conducted on the differences in home health utilization and length of home health spells between Medicare Advantage and traditional Medicare (TM) by admission type, however. Some studies have shown lower utilization of post-acute care in general among Medicare Advantage enrollees, and one study showed Medicare Advantage enrollees were less likely to use home health and had shorter spells when they did use those benefits, but neither differentiated between post-acute and community-admitted home health care use. Observers and policymakers have long questioned the appropriate role of home health in Medicare and in the delivery of care more broadly. Ensuring appropriate use has been difficult, and the benefit has a history of fraud, waste, and abuse. Prior research has shown substantial geographic variability in the use of post-acute care services within traditional Medicare, including home health, that cannot be explained by differences in patient needs. MedPAC suggested in a 2011 Report to Congress that this geographic variation may indicate overuse or fraud and abuse. Centers for Medicare & Medicaid Services (CMS) has recently implemented policies in traditional Medicare designed to address fraud and abuse in home health care. For example, in 2013, CMS temporarily banned new HHAs from enrolling in the Medicare program in six metro areas due to high rates of fraud, and this ban was expanded statewide in Florida, Illinois, Michigan, and Texas in mid-2016. This moratorium has since expired but may have disproportionately affected home health use in traditional Medicare, as Medicare Advantage home health benefits were already more actively managed prior to the moratorium, including through selective contracting to form networks. While MedPAC has observed reductions in home health provider supply in moratorium states, particularly Florida and Texas, to our knowledge no studies have explored changes in traditional Medicare home health care use in moratorium states compared to non-moratorium states, or assessed the effects of the moratorium on traditional Medicare compared to Medicare Advantage. This mixed-methods study examines changes in patterns of post-acute and community-admitted home health care use between 2011 and 2016, focusing on differences between Medicare Advantage and traditional Medicare and across Medicare Advantage contract types in response to the following research questions: (1) How has use of home health care changed over time in Medicare Advantage compared to traditional Medicare, nationally and by state? (2) Did states with a moratorium on new HHAs have different changes in home health care use in Medicare Advantage compared to traditional Medicare than states without a moratorium? (3) Do changes in home health care use vary by Medicare Advantage contract type? (4) How have hospital admissions for home health users changed over time in Medicare Advantage compared to traditional Medicare? Our quantitative analyses are supplemented by qualitative interviews to explore why home health use differs between Medicare Advantage and traditional Medicare. Our quantitative and qualitative analyses focus on exploring how home health use is changing in both Medicare Advantage and traditional Medicare over time, including both community-admitted and post-acute home health care.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (iii, 16 pages))
- NLM Unique ID:
- 101775106 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101775106