Medicare Advantage plans sending skilled-nursing patients home too soon, advocates say

Providers, nursing home representatives and advocates for patients say Medicare Advantage plans are sending enrollees home from skilled nursing and rehabilitation centers before they are healthy enough to leave, according to an Oct. 3 Kaiser Health News and Fortune report. 

Medicare Advantage plans are paid a monthly fee for each enrollee by CMS. This can create incentives for providers to deny services to increase profits, according to an analysis from the Health and Human Services Department's inspector general that was cited in the report. 

Patricia Maynard, 80, told the outlet she was informed her Medicare Advantage plan would no longer cover her stay in a nursing home to recover from hip replacement surgery, a decision her physicians disagreed with. 

She had to make repeated appeals to her plan to have the entire length of her stay covered. 

Rajeev Kumar, MD, vice president of the Society for Post-Acute and Long-Term Care Medicine, and chief medical officer at post-acute provider Symbria health, said disagreements between insurers, providers and care facilities have become more common as Medicare Advantage enrollment increases. 

"It's not just one plan," Dr. Kumar told Kaiser Health News. "It's pretty much all of them." 

Read the full report here.

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