Medicare Advantage Reimbursement Structures Impact Home Health Delivery and Outcomes
Summary:** This study analyzes how Medicare Advantage (MA) payment models affect home health agency (HHA) delivery for wound care, finding MA patients receive 20% fewer visits and 15% higher costs due to prior authorizations and lower reimbursements vs fee-for-service. For pressure ulcers and surgical wounds, MA delays care (e.g., dressing changes), leading to 10% higher readmissions. Recommendations include streamlined approvals and value-based adjustments to improve outcomes for diabetic and elderly patients.
Key Highlights:
- MA vs FFS: 20% fewer visits; 15% higher costs for wound care services.
- Wound Impact: Pressure ulcers/surgical wounds in MA patients show 10% slower healing.
- Barriers: Prior auth delays (50% of claims); lower per-visit rates.
- Solutions: National standards for approvals; HHA incentives for MA patients.
- Implications: Affects 50% Medicare; calls for policy reform to protect vulnerable wounds.
Keywords: Medicare Advantage, home health, wound outcomes, prior authorization, pressure ulcers