It’s starting to feel like every week brings another reason to begrudge Medicare Advantage plans their market-dominating growth.

On Friday, a new study revealed a key patient experience perspective that nursing home employees have been screaming about from rooftops for years now.

Despite previous data that has shown post-acute outcomes don’t suffer when patients are covered by MA, those patients themselves report fewer days in care and less functional improvement after hospitalization or surgery.

It’s a critical finding that policymakers must consider as they move toward more value-based arrangements that are incentivized to limit post-acute care. Such efforts have a real impact on patients. Sure, their morbidity rates may not change if they skip rehab in a nursing home. But isn’t the true goal of medical intervention to restore health and quality of life?

Why is the MA system covering needed acute interventions but not investing in follow-up care that offers a better path to true and lasting recovery?

Not only do such choices degrade patient outcomes that matter, but they put the squeeze on the very providers who may be best equipped to restore function after a heart attack, fall or knee or hip surgery.

Of course, it’s no surprise that post-acute providers are taking the hit.

We’ve known who pays the price in this new system since MA plans began siphoning a larger share of beneficiaries away from traditional Medicare and the cumulative effects of that shift came clearly into view. 

But I didn’t realize until last week that MA plans are increasingly shortening their billing cycles, creating even more hoops to jump through. Many are now making skilled nursing providers bill them within 30 to 90 days, while traditional Medicare gives a year.

That can force billers to keep track of potentially dozens of billing timelines if they’re in a market with voluminous plan options. 

Couple that with too-frequent claim rejections and it’s easy to see why providers are missing out on reimbursement for services they’ve already provided. Each follow-up can take hours on hold just to be able to to understand why a payment was denied and resubmit the “right” way.

What skilled nursing back office has time for that?

It’s almost as if it’s intentional. In fact, it smacks of anti-Medicaid expansion states now under pressure from CMS to slow their post-COVID unwinding processes because they’re cutting people too quickly. The barrier in many of those states has been bureaucratic paperwork and a lack of customer service that can leave would-be Medicaid beneficiaries holding for hours if they call for guidance on how to maintain their coverage.

CMS has stepped in on those cases, but when it comes to serving those who serve Medicaid and Medicare patients, the agency remains oddly silent. It’s an issue that Congress, finally demanding more from MA plans when it comes to denials, also has not intervened on.

Some in the sector say all of the added hassle of collecting MA payments can require adding full-time staff, the cost of which must be borne by the very providers forced to accept unacceptably low MA rates in the first place.

The problem is that when skilled nursing providers miss tighter deadlines or don’t collect MA payments they’re due because they can’t waste yet more hours holding on the phone for basic information, experts tell me they’re unable to write off those losses.

That’s yet another costly variation from traditional Medicare.

On the backside of this, there are insurance companies making huge amounts of money. The largest MA plan providers nationally in 2023, according to KFF, are UnitedHealthcare with 29% of the market, and Humana, with 18% of the market.

UnitedHealthcare CEO Andrew Witty made $20.9 million in 2022, about a 13% raise over his 2021 compensation. Humana’s President and CEO Bruce Broussard made $17.2 million in 2022.

Those are handsome rewards for individuals overseeing policies and practices that are blowing up the post-acute care economy and ultimately hurting American seniors.

As Congress returns from break next month, let’s hope members keep the heat on MA and begin to weigh just how much both access to care and reimbursement practices matter for beneficiaries and providers.

Kimberly Marselas is senior editor of McKnight’s Long-Term Care News.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.