Medicare Advantage patients face longer hospital stays: Report

New research conducted by NORC at the University of Chicago found that Medicare Advantage enrollees are more likely to face longer hospital stays and less likely to receive certain follow-up care than traditional Medicare beneficiaries.

NORC is a nonpartisan research organization. The study was commissioned by the Coalition to Strengthen America's Healthcare, which describes itself as a "grassroots organization advocating for accessible, high-quality healthcare for all Americans."

The researchers set out to understand how hospital discharges to post-acute care (PAC) settings and length of stay at preceding hospitals differed by Medicare coverage.

Access to PAC can help patients recover from illnesses and reduce readmission rates. PAC is also known to be a valuable setting for older adults who often experience functional declines after a traditional hospital stay.

NORC researchers analyzed data from 2018 to 2022, revealing that Medicare Advantage patients had hospital stays that were 40% longer on average than those with traditional Medicare. During the study period, Medicare Advantage hospital discharges to PAC increased by 5.6%, while traditional Medicare hospital discharges to PAC settings decreased by 1.5%. PAC settings include skilled nursing facilities (SNF), home health agencies (HHA) and long-term acute care hospitals (LTACH).

However, as of 2022, traditional Medicare discharged to higher acuity PAC settings -- such as long-term acute care hospitals, skilled nursing facilities and inpatient rehabilitation hospitals -- more frequently than Medicare Advantage.

The findings also revealed that Medicare Advantage beneficiaries experienced longer hospital stays prior to PAC discharge compared to traditional Medicare enrollees. The median hospital length of stay prior to discharge remained at five days for traditional Medicare beneficiaries during the study period, while increasing from six to seven days for Medicare Advantage beneficiaries.

Further, Medicare Advantage beneficiaries consistently experienced longer hospital stays prior to LTACH, IRF, SNF and HHA discharge.

NORC noted that "there is growing evidence that prior authorization and denials may adversely affect access to post-acute care services" for some Medicare Advantage beneficiaries, citing an Office of Inspector General report that found that some Medicare Advantage plans improperly denied access to PAC settings.

The researchers also cited a July 2024 Medicare Payment Advisory Commission report that aligned with its findings on traditional Medicare discharges to PAC settings.

"While our analysis accounted for variation in Medicare coverage and enrollment trends, it's important to acknowledge differences in demographic and clinical risk profiles for Medicare beneficiaries using PAC," the NORC report stated.

NORC concluded its findings by recommending further research on the variation in PAC use by Medicare coverage type.

"Every patient deserves timely access to the right care in the right setting, especially after hospitalization," said Ed Patru, a spokesperson for the Coalition to Strengthen America's Healthcare.

"These findings raise serious concerns that Medicare Advantage plans are delaying or denying critical follow-up care that helps older adults recover, regain independence, and avoid complications."

Jill McKeon has covered healthcare cybersecurity and privacy news since 2021.