Medicare Advantage (MA) beneficiaries are less likely to receive intensive treatments or burdensome transfers during the last six months of life compared to those in traditional Medicare, a new study has found.
MA enrollees were also more likely to receive hospice care and less likely to receive facility-based care after a hospital discharge, according research published in JAMA Health Forum.
A key factor is MA’s focus on controlling costs, whereas fee-for-service Medicare incentivizes more aggressive treatment, researchers indicated. However, they identified gaps in which patients don’t always receive sufficient post-acute care.
“We found that MA enrollment was associated with lower rates of potentially burdensome hospitalizations and treatments, less skilled nursing facility care and more home care after discharge,” study authors wrote. “Financial incentives to reduce costs in MA appear to promote less use of potentially burdensome treatments but also leave some patients without home-based or facility care after hospitalization.”
For the study, researchers examined Medicare claims data for more than 1 million patients who died between 2016 and 2018.
Results indicated that MA beneficiaries were 1.6% less likely than those in traditional Medicare to receive aggressive treatment during the last six months of life and were 3.3% less likely to die in a hospital. MA enrollees were also 5.2% less likely to go to a skilled nursing facility post-discharge.
MA enrollment also correlated to a small degree with higher rates of hospice utilization. However, overall hospice election during the last 30 days before death hovered around 16%.
Though MA beneficiaries were somewhat more likely to receive home-based care, the study authors noted some caveats, including the potential burden on family caregivers and the complexity of navigating both MA coverage and the Medicare Hospice Benefit.
“Financial incentives in Medicare Advantage, the managed care alternative to traditional Medicare, were designed to reduce overutilization,” the authors wrote. “For patients near the end of life, MA incentives may reduce potentially burdensome care and encourage hospice but could also restrict access to costly but necessary services.”
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