“MA plans shed sickest patients in their final year of life, shifting costs back to government”

“MA plans shed sickest patients in their final year of life, shifting costs back to government,” by Kimberly Marselas, McKnights LTC News

“A new Wall Street Journal analysis has found that private Medicare Advantage plans often shed their sickest patients in the final year of life, shifting the most expensive portion of their care back to the government. … The analysis also pointed a finger at management tools employed by the plans, including the extensive use of prior authorizations and denials of care that can force patients to leave certain care settings before their clinicians say they’re ready. … But the analysis found that patients who switched at the end of life more easily found their way into post-acute and long-term care settings. Almost 20% received nursing-home services within a week of re-enrolling in traditional Medicare. That’s compared to just 3.9% of all fee-for-service, end-of-life beneficiaries in a typical week.”

LTC Comment, Stephen A. Moses, President, Center for Long-Term Care Reform:

Nursing homes have long complained that Medicare Advantage plans disadvantage insureds and their LTC providers by reducing care access and cutting revenue, respectively. Evidently shifting back to traditional Medicare when late-life health costs spike is a way for beneficiaries to get the earlier MA benefits while maximizing traditional benefits later, benefiting both themselves and the private insurers at Medicare’s expense.