Tuesday, October 4, 2022
Kaiser Health News just released this story, Nursing Home Surprise: Advantage Plans May Shorten Stays to Less Time Than Medicare Covers.
Health care providers, nursing home representatives, and advocates for residents say Medicare Advantage plans are increasingly ending members’ coverage for nursing home and rehabilitation services before patients are healthy enough to go home.
Half of the nearly 65 million people with Medicare are enrolled in the private health plans called Medicare Advantage, an alternative to the traditional government program. The plans must cover — at a minimum — the same benefits as traditional Medicare, including up to 100 days of skilled nursing home care every year.
But the private plans have leeway when deciding how much nursing home care a patient needs.
One expert interviewed for the story noted that "[a]s Medicare Advantage enrollment has spiked in recent years, ... disagreements between insurers and nursing home medical teams have increased. In addition, [the expert] said, insurers have hired companies, such as Tennessee-based naviHealth, that use data about other patients to help predict how much care an individual needs in a skilled nursing facility based on her health condition. Those calculations can conflict with what medical teams recommend...."
This is an important issue. Read this story.