Advocates resist call for Five Star ratings change for dual-eligibles

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A major beneficiary advocate is pushing back on a new study recommending Medicare Advantage rates be adjusted for dual-eligible patients because so many tend to have poorer outcomes than others.

The study, conducted by a health technology company and a trade group for Medicare special needs plans, claims that the current MA ratings system may not reflect the actual quality of care due to those patients' “significantly” worse health outcomes. Study authors say their research supports the need to adjust MA Five-Star Rating System measures that account for “clinical, sociodemographic and community resource factors in order to ensure a fair evaluation of the actual performance of MA plans.”

MA plans receive bonus payments from the government for high ratings.

The "White Paper: An Investigation of Medicare Advantage Dual Eligible Member-Level Performance on CMS Five-Star Quality Measures" was released Monday.

Key representatives from academia and public health generally support the study's findings, but Judith Stein, the executive director of Center for Medicare Advocacy, is not among them. Stein told Bloomberg News services that traditional Medicare serves dual-eligible patients better than MA plans, and wasn't surprised “they fare less well in MA plans.”

The year's first shot across the bow on dual-eligible care came in mid-March when companion bills aimed at mitigating hospital readmission penalties were introduced in Congress. Critics of the Hospital Readmission Reduction Program claim it unfairly punishes hospitals treating low-income and dual-eligible patients.