A retrospective study analyzed Medicare Advantage members’ outcomes after acute hospitalization, comparing those receiving home health services versus those who did not. The research highlights the importance of addressing barriers to home health access, including patient refusal and logistical challenges.
Key Takeaways
Following acute hospitalization, Medicare Advantage members with orders to receive home health may not ultimately receive these services for member- and health care system–related reasons.
Common reasons for unfulfilled home health referrals include member refusal of service and an inability to contact or locate the member.
Among those with discharge orders to receive home health, those who did not receive service experienced significantly higher mortality at 30, 90, and 180 days.
Because referring hospital physicians believe that their members will receive home health and may plan their discharges accordingly, it is highly important to address gaps in understanding, anticipate barriers to service, and strengthen communication between inpatient teams and home health agencies.
Gada, E., MD, Mha, P. P., Mba, C. S. M., Mph, C. P. S., & Ms, R. Y. (2024, July 12). Unfulfilled home health referrals lead to higher mortality among Medicare Advantage members. AJMC. https://www.ajmc.com/view/unfulfilled-home-health-referrals-lead-to-higher-mortality-among-medicare-advantage-members
Rowan, T. (2024, October 31). UnitedHealth Study: Is Medicare Advantage Killing Seniors. The Rowan Report. https://www.therowanreport.com/2024/10/25/is-medicare-advantage-killing-seniors/
Berger, L. (2024, July 17). Unfulfilled MA referrals for home healthcare can lead to ‘grave consequences,’ study finds. McKnights Home Care. https://www.mcknightshomecare.com/news/unfulfilled-ma-referrals-for-home-healthcare-can-lead-to-grave-consequences-study-finds/
Steele-Adjognon, M., Kelley, C., & Koenig, L. (2024). Fewer hospitalized Medicare beneficiaries are receiving recommended home health care. www.commonwealthfund.org. https://doi.org/10.26099/vq7d-8e24
Improve Medicare Advantage reimbursements with payer contract management that puts payer rules in the hands of clinicians & billers.
