Medicare Advantage

Medicare Advantage is an alternative to the original Medicare plan that often includes more benefits than the original and bundles coverage for hospital and medical services. However, Medicare Advantage also greatly complicates the process of transitioning between hospitals and nursing homes, which ultimately endangers the patients and provides health care providers with bigger headaches.

Skilled Nursing News reported on how Medicaid cuts will allow for profit Medicare Advantage Organizations neglect vulnerable adults. As the adoption of Medicare Advantage rises and Congress’s cuts to the Medicaid budget take place, Nursing Homes and hospitals are fighting new challenges.

Essentially, Medicare Advantage allows too much time to make the preauthorization decisions necessary to transfer a patient. This can result in patients having extended hospital stays before moving to a nursing home. In fact, Medicare Advantage patients are recorded to be 3.1% more likely to have hospital stays over 14 days before transferring, which cost hospitals $5.5 billion in discharge delays in 2023.

Outside of Medicare Advantage, patient transfers are already difficult, largely due to the amount of paperwork employees must complete, read, digest, and use to make decisions about the best care for the patient. The sheer amount of documentation that must be handled, along with the extensive number of team members that should work together to make decisions, can also increase the length of hospital stays or cause the wrong care to be recommended to patients. This may also result in more medical efforts being committed, such as different health care providers prescribing patients with different medications that should not be taken simultaneously.

To prevent this, experts recommend that facilities focus on proactive planning, especially in anticipation of increased budget cuts. Facilities are also being encouraged to adopt modern technological tools like AI to facilitate safer and easier patient transfers.

In the end, policymakers have allowed for increased waste of treatments and finances, as well as placed patients at higher risk simply due to their ignorance of the reality of healthcare. The EVP of health care strategy and policy at Consensus, Bevey Miner, recommends that legislators instead work to review certain ICD-10 diagnosis codes if they really want to improve U.S. healthcare efficiency. Perhaps it’s time those in power start listening to healthcare experts when making life-changing healthcare decisions.