Medicare Advantage Enrollees Spend Less Time in Rehab

A study published in PLOS Medicine found that Medicare Advantage (MA) enrollees spend less time in nursing communities after surgery and are less likely to go back to the hospitals compared with those in traditional Medicare, reports Modern Healthcare . The researchers determined MA enrollees spent five fewer days in skilled nursing communities on average and had 463 fewer minutes of rehabilitation therapy for hip fractures. MA enrollees also were less likely to go back to hospitals, less likely to become a long-term resident at a nursing community, and were more likely to remain in their communities after release from rehab compared to fee-for-service Medicare beneficiaries. "The results suggest that for hip fracture subjects who are otherwise healthy, longer lengths of stay in skilled nursing communities may not translate to better outcomes," says Brown University Professor Vincent Mor. The Medicare Payment Advisory Commission estimates that Medicare spending for skilled-nursing services in fiscal 2002 was $14.5 billion, about 5.6 percent of total Medicare spending. By 2016, that budget was $29.1 billion or roughly 8 percent of Medicare spending. The Brown team examined claims for 211,296 fee-for-service and 75,554 MA enrollees with hip fractures who moved directly into a skilled-nursing community following hospitalization from 2011 to 2015. The difference in length of stay at skilled-nursing communities and outcomes may be attributed to factors that include MA plans' narrow networks comprised of providers with high-quality scores and low spending habits. MA plans also have stronger care-management protocols in place, including case managers and nurse practitioners to monitor enrollees after they leave a hospital, and the study indicates this leads to preventable hospitalizations.