CMS’ Medicare Benefit Policy Manual
The Medicare Benefit Policy Manual is published online by the U.S. Centers for Medicare & Medicaid Services, or CMS. Its used by health care providers, contractors, Medicare Advantage companies and…
The study found that beneficiaries attributed to ACOs were more likely to enter high-quality SNFs compared to those in MA plans or traditional Medicare, irrespective of dementia diagnosis. This suggests that the type of payment model influences access to higher-quality care in SNFs.
With the growing number of Medicare beneficiaries attributed to Accountable Care Organizations (ACO) or enrolled in Medicare Advantage (MA) and their financial incentives to lower the cost of the cared patients, it is essential to understand how these alternative payment models affect post-acute outcomes among beneficiaries, with or without dementia diagnoses. In this study, we examined the quality of skilled nursing facilities (SNFs) that beneficiaries entered after hospital discharge under different payment models.
Among SNF admissions from 2013 to 2018, the share of ACO-attributed beneficiaries increased from 7.6% to 20.2%, MA enrollees increased from 25.2% to 32.8%, and non-ACO-attributed TM enrollees decreased from 67.2% to 47.3%. Consistently, ACO-attributed beneficiaries were the most likely, while MA enrollees were the least likely to enter high-quality SNFs, regardless of dementia diagnosis.
Our findings highlight significant differences in access to high-quality SNFs across Medicare payment models, with ACO-attributed beneficiaries consistently experiencing better access than their MA or traditional Medicare counterparts, regardless of dementia diagnosis. These results underscore the need for further investigation into how payment models influence care quality and access, particularly for vulnerable populations.
Wang, H., Kosar, C., Rahman, M., & Mor, V. (2024). Do Medicare beneficiaries under Accountable Care or Medicare Advantage use lower quality nursing homes? Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.19328
O’Connor, J. (2025, January 10). ACO beneficiaries most likely to land in high-quality nursing homes McKnight’s Long-Term Care News. https://www.mcknights.com/news/aco-beneficiaries-most-likely-to-land-in-high-quality-nursing-homes/
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