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An extensive body of research exists highlighting the differences in post-acute care utilization between fee-for-service (FFS) Medicare beneficiaries and those enrolled in Medicare Advantage (MA).

Generally, that research has suggested that MA enrollees utilize post-acute care services less than their FFS counterparts, often with either better or equal health outcomes. A study published Friday in JAMA Health Forum questions that idea, however.

“These findings highlight the importance of assessing patient-reported outcomes, especially as MA and other payment models seek to reduce inefficient use of post-acute care services,” the study’s authors wrote.

Post-acute care includes services delivered by skilled nursing facilities (SNFs) and home health agencies, in addition to long-term care hospitals (LTCHs) and inpatient rehabilitation facilities (IRFs). In the home health world, FFS patients have historically made up the bulk of providers’ census, but that’s rapidly changing as MA enrollment climbs.

To explore differences in post-acute care utilization and outcomes between FFS Medicare and MA beneficiaries, researchers from Vanderbilt University Medical Center and VA Tennessee Valley Healthcare System looked at data from the National Health and Aging Trends Study (NHATS), with linked Medicare enrollment data from 2015 to 2017. The team only used data from community-dwelling FFS and MA beneficiaries 70 years and older, with dual eligibles not excluded.

After crunching the numbers, researchers came up with a sample population of 2,357 beneficiaries to examine. Of those, 815 beneficiaries were Medicare Advantage enrollees, with the remainder – 1,542 individuals – on FFS Medicare.

Overall, there was a clear difference in post-acute care utilization between MA and FFS beneficiaries, with MA enrolled using services such as home health care significantly less. Even more interestingly, according to the study’s findings, MA enrollees had weaker self-reported outcomes.

“In this cohort study of 2,357 Medicare beneficiaries who used post-acute care services, MA enrollees reported less use of post-acute care services and shorter duration of services vs. traditional Medicare beneficiaries,” the study’s authors wrote. “Fewer MA enrollees reported functional improvement while using post-acute care.”

What’s more, roughly one-third of MA enrollees reported receiving post-acute services for 4 weeks or less compared with 24.3% of FFS enrollees.

But the fact that MA enrollees utilized post-acute care less isn’t surprising.

Traditional Medicare’s fee-for-service reimbursement system potentially “encourages overuse” of post-acute care services, according to the study. In contrast, capitated rates paid to MA may incentivize plans to steer patients to less expensive settings, limit service duration or refuse prior authorization for post-acute care.

The differences in outcomes is somewhat surprising.

“To our knowledge, less post-acute care use among MA enrollees has not had measurable associations with unfavorable outcomes in studies to date,” the authors wrote.

The study doesn’t make any claims as to why those differences exist, but its authors emphasize the importance of following up further considering FFS vs. MA trends in the U.S.

MA enrollment is estimated to reach approximately 61% by 2032.

That growth includes rising numbers of MA enrollees with low incomes who have dual Medicare-Medicaid eligibility, have high rates of post-acute care use and may be more adversely affected by efforts to ration services.

“Findings of the present study suggest that self-reported data from Medicare beneficiaries may introduce important evidence about potential declines in patient satisfaction that should be investigated as Medicare seeks to expand payment models that promote more efficient use of post-acute care services,” the authors wrote.

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