Differences in Initiation and Receipt of Home Health Care: Traditional Medicare Versus Medicare Advantage.

Background: Because Traditional Medicare (TM) and Medicare Advantage (MA) have different reimbursement structures and incentives, it is important to understand differences in home health agency (HHA) use by payer type.

Objective: To quantify differences in care patterns and outcomes between TM and MA HHA users.

Research design and subjects: Medicare HHA claims were used to identify postacute HHA episodes among US adults aged 65 and older enrolled in MA or TM (2015-2019). Adjusted regression models with and without HHA fixed effects assessed whether TM and MA beneficiaries are treated differently within an HHA.

Measures: We examined process (timely initiation of care, receipt of a skilled nursing visit, and length of stay) and quality measures (hospital readmission and healthy days at home).

Results: The study included 4,029,527 beneficiaries (3,034,452 TM and 995,075 MA). We identified large differences in the share of beneficiaries experiencing timely initiation of care (81.4% TM vs. 77.4% MA) and receipt of skilled nursing visits (86.8% TM vs. 81.9% MA). After including HHA fixed effects in the regression model, MA beneficiaries were 2.1 percentage points (pp) less likely to experience timely initiation of care and were 3.1 pp less likely to receive a skilled nursing visit (and 8.9 pp less likely to receive any type of skilled visit) within 2 days of starting HHA care compared with TM beneficiaries ( P <0.001).

Conclusions: Our findings suggest differential treatment between MA and TM beneficiaries within the same HHA. Further research is needed to understand the mechanisms driving these within-agency differences.