According to researchers at Brown University, there is a discrepancy in the standard of care between those on Medicare Advantage plans and those on traditional Medicare.
To simplify, the research revealed that seniors on Medicare Advantage plans were not receiving the same quality of care as those on Medicare. The study pointed out that those on traditional Medicare were between 4.9 and 2.8 times more likely to receive “high-quality care” than those on lower-rated Medicare Advantage plans.
Now, discrepancies in care are nothing new. No matter how hard providers might strive to deliver the same standard of care across the board, there are differences in apportionment of funds, eminence of overall available services, and so on. There are a number of reasons for this inconsistency. Usually.
The Study’s Methodology
The Brown University study set out with a critical question in mind: “Do Medicare Advantage beneficiaries receive a different quality of care from home health agencies than traditional Medicare beneficiaries do?”
Researchers performed a cross-sectional study of over four million home health agency admissions. This was done using Outcome and Assessment Information Set (OASIS) admission assessments. Researchers determined the quality ratings of various facilities and services by probing data provided by public patient care reports, namely the “star ratings” from the Centers for Medicare & Medicaid Services Home Health Compare website.
Quality standards were established as researchers determined home health agencies as “low quality” if the rating was between one and two and a half stars. Home health agencies that were high quality had a star rating of four stars or more.
In essence, pricing has a lot to do with what the researchers found.
Medicare Advantage plans are required to provide the same minimum healthcare services as Medicare plans, but Medicare Advantage plan beneficiaries receive care from their plan’s network of “preferred healthcare organizations and/or professionals.” In the case of traditional Medicare, beneficiaries can choose to receive care from any certified healthcare organization and/or professional.
The basic thrust is that Medicare Advantage plans can block consumers into networks with lower-quality home health agencies, which in turn are operational because they are willing to accept lower prices.
According to the study, traditional Medicare recipients had a 17 percent chance of receiving what would qualify as low-quality care. They had a 30.4 percent chance of receiving what would classify as high-quality care.
Conversely, those with low-rated Medicare Advantage plans were three percent more likely to receive what would qualify as low-quality care. And they had a 25.5 percent chance of receiving high-quality care, which is about a five percent difference from those with traditional Medicare.
Naturally, income comes into play. And so does geography, as the study discovered those with access to low-quality home health agencies were essentially limited by their surroundings. All three plan categories were more likely to offer low quality options with high-quality home health agencies further away.
So what can be done about this? Seniors can be effectually trapped into receiving lower quality care because providers are trying to save money and because there are no geographically viable options for better care. This is unacceptable.
With more Baby Boomers entering retirement and turning to home health agencies, it’s more important than ever to develop a reliable standard of care.
That could start with offering inducements to Medicare Advantage plans to include higher-quality home health agencies as part of their networks. By boosting the fundamental quality of the networks, the prospect of receiving better care is increased.
The Centers for Medicare & Medicaid Services would be well-served to take a long look at the ratings system. One of the issues plaguing this discussion is the reliability and modernity of the ratings themselves. Better, more transparent rating criteria is essential, as is the obligation of providing accurate information to beneficiaries about all accessible care facilities and agencies.
There are measures in place, but it can be hard to sort self-interested decision-making from the humane. Saving money and meeting budgetary requirements will always be part and parcel to any profit margin, but doing so without weakening the quality or availability of care continues to be a tightrope worth walking.
As policymakers address this and other issues related to Medicare and Medicare Advantage plans, the importance of justice, value for money and the accessibility of high-quality care cannot be overstated.