A new report comparing health outcomes for beneficiaries of Medicare Advantage (MA) and those on traditional fee-for-service Medicare put hard numbers to the differences in skilled nursing facility stays between the two groups.
The findings show that MA beneficiaries spend far fewer days in SNFs than those covered by traditional Medicare. Specifically, SNF stays were 29% lower per 1,000 MA members, compared with those enrolled in traditional fee-for-service Medicare.
The report, from the Better Medicare Alliance (BMA) with analysis conducted by the consulting firm Avalere Health, studied data on more than 1.4 million MA beneficiaries and 7.9 million traditional Medicare beneficiaries on various quality measures.
BMA is an organization that supports MA with a range of stakeholders.
According to the analysis, high-need, high-cost MA beneficiaries had lower rates of post-acute utilization in all settings, compared with those in traditional Medicare. SNF days were 16% to 41% lower in MA, compared with traditional Medicare across all high-need, high-cost populations, the report found.
The report generally determined that differences in post-acute care costs aligned with differences in the use of post-acute care in all populations, including the Medicare population overall — but Medicare Advantage costs for SNFs were an exception.
“Medicare Advantage costs [for SNFs] were 162% higher for beneficiaries with major complex chronic conditions and 7% higher for frail elderly beneficiaries compared to traditional FFS Medicare even though rates of utilization of care in these populations were substantially lower,” the report concluded. “Higher costs in skilled nursing facilities in Medicare Advantage also occurred in the overall matched Medicare populations, where skilled nursing costs were 17% higher in Medicare Advantage than in traditional FFS Medicare.”
MA has been gaining ground across the U.S., even though national MA penetration comes to only about a third of eligible beneficiaries, and experts have noted that “it’s happening organically.”
“It’s happening: Medicare is being privatized by Medicare Advantage, any way you slice it,” Marc Zimmet, president of reimbursement consulting firm Zimmet Healthcare Services Group, said during a presentation at the eCap health care summit in Florida in February of this year.
In BMA’s view, that’s not a bad thing.
“This study finds that overall Medicare Advantage delivered robust positive outcomes for high-need, high-cost beneficiaries compared to similar populations in traditional FFS Medicare,” it concluded. “Higher utilization of preventive screenings, preventive therapy, and post-acute care follow-up in Medicare Advantage suggests that care management results in higher quality of care for this vulnerable population.”
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