February 28, 2023
Payers | Tea Leaves
  • A new study found that Medicare Advantage (MA) had fewer avoidable hospitalizations for acute conditions compared to traditional Medicare, a trend that may be caused by shifting patients to other sites of care. The study, published in the Journal of the American Medical Association (JAMA) last week, compared hospitalization rates between Medicare fee-for-service and MA. The study found MA had fewer avoidable hospitalizations than traditional Medicare, which may have been due to patient shifts such as emergency direct discharges and observation stays. The findings come amid increased scrutiny on how the federal government pays MA plans. The Centers for Medicare & Medicaid Services released a final rule late last month that overhauled risk adjustment audits for plans to ensure accuracy in payments and a proposed pay rate change that insurers call a cut for 2024 payments. (Article here)