A recent study found that Medicare Advantage quality ratings had little correlation with the quality of end-of-life care. The study published in the Journal of the American Geriatrics Society calls into question whether MA plans have any incentive to improve the quality of care at the end of life.
The study comes at a critical time as the Centers for Medicare and Medicaid Innovation is in the second year of a test of the Value-based Insurance Design model (VBID), which would include a Part A hospice benefit within MA plans.
Researchers from six universities who collaborated on the study analyzed data from more than 200,000 MA plan enrollees over age 66 with twelve months of continuous coverage who died in 2016. The team considered patients enrolled in 2.5 to 3-star rated contracts and those in 4.4-5-star contracts. Outcomes included patient care settings at the time of death, care received in the last 30 days of life and care intensity.
Medicare compares plans ahead of the annual open enrollment period which begins in the fall. Plans are rated on a scale of one to five, with one star representing poor performance and five stars representing excellent performance. Star ratings are released annually and reflect the experiences of people enrolled in Medicare Advantage and Part D prescription drug plans. The rating system is intended to help consumers choose the plan that is best for them.
The researchers found that “particularly, highly-rated MA contracts were not associated with improved access to hospice.”
The team said the results have significant policy implications as the current quality rating system does not factor in measures for end-of-life care, so MA plans have no real incentive to improve the care quality at the end of life.
“MA plans do have powerful economic incentives to refer persons to hospice under the current ‘hospice carve-out” policy and likely lack explicit hospice networks,” the study stated.” If a decision is made to carve hospice into MA programs, it is important that quality measures are created and used in star rating to provide consumers and healthcare providers with critical information on the quality of MA plans in the care of the seriously ill.”
CMS is testing the VBID model to assess the impact on care delivery and quality of care, especially for hospice and palliative care when MA plans are financially responsible for all of Parts A and B benefits.
