Patient feedback should help guide Medicare Advantage post-acute care policy: study

Medicare Advantage (MA) plans should obtain feedback from beneficiaries concerning how much post-acute care helped them recover after being hospitalized, according to a study in JAMA Health Forum.

Researchers with Vanderbilt University Medical Center found that MA beneficiaries overall used fewer post-acute care services than enrollees in traditional Medicare and also reported less favorable outcomes, something that policymakers should keep in mind as MA keeps growing and the health insurers who run such plans attempt to cut back on what they might perceive as inefficient use of post-acute care services.

The study noted that fee-for-service Medicare spent about $57 billion on post-acute care services in 2020.

Corresponding author Emma Achola told Fierce Healthcare in an email that “the paper provides some evidence that there may be some gaps in care satisfaction that Medicare Advantage plans should take into consideration in order to ensure patients are getting the right care at the right time.”

The study cited prior research saying that MA beneficiaries are more likely to have a successful discharge to a community and to remain in a community longer post-discharge than those with traditional Medicare. In addition, there was no noticeable mortality differences between MA and Medicare beneficiaries, although MA enrollees were less likely to be readmitted to the hospital.

However, the researchers point out that those studies relied solely on administrative data and did not include self-reported patient data. “Examining self-reported patient outcomes is key to ensuring that the MA program adequately meets beneficiaries’ needs, particularly since there is evidence that MA enrollees are treated at lower-quality SNFs,” the JAMA Health Forum study said.

Researchers used data from the National Health and Aging Trends Study for self-reported measures of post-acute care use and outcomes collected in interviews conducted between 2015 and 2017. Participants included individuals aged 70 or older who completed the survey who lived in a community rather than a nursing home. They focused on groups more likely to use post-acute care and with similar health conditions to minimized hidden differences between MA and TM populations.

The study noted that MA achieved savings by evaluating administrative data in its Medicare Shared Savings Program and also mandatory bundled payments which were said to decrease use of post-acute care without any adverse outcomes. Researchers said that MA plans need to ask the patients themselves and investigate if there’s any decline in satisfaction scores.

In addition, differences in perceptions of improvement might be tied to MA utilization management, according to the study. Requiring prior authorization for post-acute services might lead to delays in beneficiaries receiving those treatments or might be the cause of the services being terminated before the beneficiary is ready.

"By self-reported we mean that patients are directly asked questions about their perceptions of functional improvement and whether they met their goals," Achola said. "Patients are able to perceive how the care they received made them feel so I think it is reasonable to expect beneficiaries to have valuable responses to these kinds of questions. Patient-reported outcomes allow policymakers to understand care processes not captured in claims or administrative data and should always have a place in how we assess quality of care.”