As a result of insufficient and slow payments, Medicare Advantage (MA) plans are creating “an untenable situation” for home care providers, Amedisys Chairman and CEO Paul Kusserow told McKnight’s Home Care Daily Pulse.
“It’s an extraordinarily tough piece of business to take,” he said in a podcast at the Home Care 100 Leadership Conference this week. “As Medicare Advantage continues its growth and if it continues to pay us the way they are now, it’s an untenable situation. I think we’re coming towards what potentially could be a real sort-out with Medicare Advantage, because their members are demanding home health. Most of their members want to be taken care of in the home. At the same time, they can’t pay us a pittance and still expect good quality.”
His comments come as MA plans continue to make serious inroads in the home care market. Research indicates MA may surpass the traditional fee-for-service as early as this year. Humana, which owns the largest home health company Kindred at Home, recently disclosed it will invest $1 billion in MA plans. And Seema Verma, the former administrator of the Centers for Medicare & Medicaid Services, noted at the conference that the program is going “gangbusters.”
But increasingly there are rumblings from the home care community that the program is coming up short. Kusserow said the plans pay 30% to 40% less than fee-for-service. He also said it takes plans four times longer to pay their bills. About 10% do not pay their bills at all because they deem it “inappropriate care,” he said.
Other home health CEOs also have expressed dissatisfaction with the private Medicare plans. Bruce Greenstein, chief innovation and technology officer for LHC Group, told McKnight’s Home Care Daily Pulse that MA contracting is “asymmetric, not fair and inefficient.”
One reason home care is finding opportunity through MA is because, increasingly, the plans provide what are called nonmedical supplemental benefits, which include transportation, a social needs benefit and structural home modifications. Nearly a quarter of the plans are offering these benefits this year, according to ATI Advisory.
