A Brown University School of Public Health study published in Health Affairs finds that Medicare Advantage plan enrollees end up in lower quality nursing homes than people in traditional Medicare. The unanswered question is why. Given the financial incentives of Medicare Advantage plans to contract with the lowest cost providers, it would make sense that their nursing home networks, much like their physician networks, more often than not include poorer quality providers than traditional Medicare.
Medicare rates nursing homes between one and five stars and while these star ratings do not necessarily reflect good quality, they are one quality measure. The Brown researchers found that people enrolled in Medicare Advantage plans are more likely to end up in nursing homes with fewer stars than people in traditional Medicare. Additional research will determine whether financial incentives lead Medicare Advantage plans to contract with both lower cost and poorer quality nursing homes than traditional Medicare.
The researchers controlled for a number of variables and found that people enrolled in fee-for-service Medicare “have substantially higher probabilities of entering higher-quality Medicare skilled nursing facilities” than people enrolled in Medicare Advantage plans, based on the nursing homes’ star ratings and their hospital readmission rates. A Massachusetts study found that health plans with narrow provider networks tended not to include prestigious hospitals and hospitals with higher star ratings.
If you or someone you love is entering a Medicare-certified skilled nursing facility, check out your options. If possible, avoid chain nursing homes, which, according to a Kaiser investigation, deliver poorer care than independent nursing homes. Unfortunately, your options may be limited if you are enrolled in a Medicare Advantage plan. And, remember, Medicare five-star ratings are only one limited measure of quality; hospital readmission rates are another.
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