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How Beneficiaries Really Feel About Medicare Advantage vs Traditional Medicare
MedPage Today | By Cheryl Clark
Survey results released today contradict widely-held beliefs that Medicare Advantage enrollees are more satisfied because they receive better health services than those in traditional Medicare.
On the contrary, respondents in the two types of Medicare plans reported equal satisfaction, although more Medicare Advantage (MA) enrollees than traditional Medicare (TM) beneficiaries said their care was delayed because of the need for prior approval.
The reportopens in a new tab or window by The Commonwealth Fund analyzed responses from 3,280 Medicare beneficiaries between November 6, 2023, and January 4 in an effort to learn "What Do Medicare Beneficiaries Value About their Coverage?" Those surveyed gave their opinions on the ease of their access to benefits, care coordination, services, and satisfaction.
"Overall, the experiences seem to be similar for those in traditional Medicare versus Medicare Advantage, with some notable exceptions," Gretchen Jacobson, PhD, vice president of Commonwealth's Medicare program, told MedPage Today.
The comparison of beneficiary experiences in each model is important because roughly half, or 52% of 66 million eligible people, are now enrolled in MA plans, to which federal funds pay billions more than for TM care. In 2024, for example, MA plans are expected to receive $88 billionopens in a new tab or window more than what would have been spent if the same people were in TM.
Although there are efforts underway to contain that spending through new payment policiesopens in a new tab or window, MA enrollment is projected to continue rapid growth. So it's important that taxpayers understand what they're getting for all that extra money.
A perhaps surprising finding of the survey was MA enrollees' relatively low use of their "extra benefits," such as vision, hearing, and dental care, considering that plans aggressively market these benefits to encourage signups. Jacobson noted that Medicare pays the plans $1,915 a year per enrollee for these benefits, according to the 2023 annual reportopens in a new tab or window from the Medicare trust funds' trustees. These extras are not covered under TM…
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Meet the 2024 APTA Home Health Award Recipients
The following recipients were nominated by various members of the Academy, and were selected based on the outlined criteria below by the executive committee of APTA Home Health. These Home Health Awards were presented to recipients at the APTA Home Health business meeting on Friday, February 16, 2024.
To view award details and recipient bios, please click here.
President's Award
- Dr. Eva Norman, PT, DPT, CEEAA
Excellence in Home Health Leadership Award
- Dr. Denise Wagner, PT, DPT
- Dr. Betsy Coyle, PT, DPT
- Dr. Paras Goel, PT, DPT, MED
Excellence in Home Health Clinical Practice Award
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Listen Now! APTA Home Health's New Podcast 'Home on the Go'!
Introducing APTA Home Health's innovative podcast, "Home on the Go" – your go-to source for insightful discussions and expert insights on all things related to PT in the home. This dynamic podcast is designed to keep you informed and engaged, offering a unique blend of informative content and real-world experiences in the rapidly evolving landscape of home health services.
Tune in to "Home on the Go" and join the conversation that is reshaping the narrative of home health care. Subscribe now on your favorite podcast platform to stay informed, inspired, and empowered with APTA Home Health's latest podcast.
Click here to listen to Episode 1! |
The Bottom Line: Top Billing, Financial Mistakes Responsible for Home Health Agency Struggles
Home Health Care News | By Joyce Famakinwa
Home health providers often make mistakes that leave money on the table at best, and at
worst, lead to financial ruin.
However, providers that learn to avoid these stumbling blocks will be better positioned to achieve longevity and financial stability.
In general, the home health consulting firm SimiTree has noticed an increase in the amount of providers that have been struggling with things like unbilled claims, inaccurate primary payer selection and more, according to Lynn Labarta, vice president of post-acute revenue cycle management at SimiTree.
In fact, Labarta recently wrote about this very topic for SimiTree.
“SimiTree has thousands of customers in the home health and hospice space all over the country, and we have been seeing an uptick in these issues and agencies struggling or feeling that they may not survive,” she told Home Health Care News.
Labarta believes that not staying on top of unbilled claims is the No. 1 issue that providers are currently struggling with. It’s an issue that pops up at companies of all sizes.
“We see this unbilled claims issue with all sorts of agencies — all the way from startups to mid-size agencies, even some of the largest agencies in the country struggle with this for different reasons,” she said.
Broadly, most providers’ EMR has a section in the software where all of the unbilled claims are housed. These are claims that can’t be billed because there is some type of hold on them. Typically it’s a clinical hold, or regulatory issue that prevents the claim from being billed.
For many providers, this is where most of the revenue lives.
“We’ve seen agencies that have thousands of claims sitting in the unbilled claims list,” Labarta said. “When you translate the thousands of claims sitting in that bucket, depending on the size of the agency, you’re talking about hundreds of thousands of dollars. Of course, if you’re dealing with a smaller agency it could be smaller dollars, but it still impacts cash flow. This makes agencies feel like they’re seeing patients and working very hard, but not seeing the money coming through the door.”…
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‘Not About A Shiny New Toy’: How Home Health Providers Are Succeeding With More Complex Patients
Home Health Care News | By Patrick Filbin
As home health patients become sicker and more complex, providers have been forced to find ways to keep their care models financially viable.
In order to combat some of those “acuity creep” challenges, industry leaders are leaning on technology, data-driven decision making and more value-based care.
“We continue to navigate through a very regulated industry,” Janice Riggins, chief clinical officer at VitalCaring, told Home Health Care News. “That continues to pose issues for us, in addition to expenses for training and education. The recruitment and retention of qualified staff that have that clinical expertise is a financial implication. All of these aspects are at a very heightened level. Now more so than ever.”
The Dallas-based VitalCaring provides home health and hospice services across six Southeastern states.
Staffing costs and physician engagement
When taking care of the sickest and most complicated patients, it’s imperative that clinicians and caregivers are properly trained and that staff resources are optimized.
“Training and education is an investment that needs to be considered,” Riggins said. “It’s really important for our staff to have continuous training in order to handle these complexities of the sicker patients, which add to that overall operational cost.”
In this care environment, clinicians must be operating at the top of their licenses, McBee Associates President Mike Dordick told HHCN.
“Unlike going in and changing a wound or basic injections, you’re going to the sicker patients where there’s a lot more that clinicians have to be able to to deal with,” Dordick said. “Your resource allocation and your staffing strategy has to be at a higher level than if it was a lower-acuity patient.”
McBee Associates is a consulting firm that works with hospitals and post-acute care providers.
Maintaining an adequate staffing level will always be a struggle for providers. The same goes for covering the costs that are necessary to take care of new-age patients.
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