News: MA plans received excess payments from hospice patients despite lower spending, report shows

Medicare Advantage (MA) hospice beneficiaries continue to face high premiums and rebate payments despite low MA healthcare spending, a new report published in JAMA Network Open suggests.

In particular, the authors sought to answer whether MA plans received excess payments for beneficiaries enrolled in hospice under the hospice carve-out model.

The researchers examined 314,087 patients enrolled in MA plans who elected hospice from 2017 through 2019. Of the 314,087 enrollees, 57.6% were female, the mean age was 80.7 years, and 39.9% were aged 85 or older. Additionally, the mean length of hospice stay was 1.76 months.

According to the researchers, within the timeframe investigated:

• Mean MA spending was down: “In the year after hospice election, mean MA spending fell to $57 per enrollee per month, with 81% of enrollees having no inpatient, outpatient, physician, skilled nursing facility, home health care, or prescription drug expenses that MA plans were liable for.”
• Yet premiums and rebate spending went up: “MA plans continued to receive $120 per enrollee per month in premiums and rebates, equating to $23 million to $58 million in excess payments to MA plans annually under scenarios in which either 50% of rebate payments or 0% of rebate payments were allocated toward supplemental benefits, respectively.”

Editor’s note: To read the JAMA Network Open report, click here.