Abstract
Introduction:
The Medicare Payment Advisory Commission (MedPAC) has documented a significant increase in the number of Medicare beneficiaries opting for Medicare Advantage, also referred to as Medicare (Part C) plans. As a result, there also has been an increase in Medicare home health beneficiaries receiving their home health through Medicare Advantage Plans. A literature review indicates there is only one quantitative study and no qualitative studies on the impact of this shift on home health on patient care, and none on home care nurses’ views on the impact on patient care.
Methods:
The current study is a qualitative study based on in-person interviews of a convenience sample of 48 home care nurses from 9 different home health agencies in New York City between January 15, 2026 and March 25, 2026.
Results and Conclusions:
Five major themes emerged, with nurses perceiving: (1) the Medicare Advantage prior authorization process denials are frequent and adversely impact patient care; (2) Medicare Advantage plans use of home health decreases the amount of home health visits; (3) decreased Medicare Advantage home health visits per patient adversely affects nurses’ ability to deliver appropriate care; (4) decreased Medicare Advantage home health visits per patient increases the likelihood of health care readmissions; and (5) decreased Medicare Advantage home health visits per patient increase the likelihood of patients developing further medical complications. Recommendations are made for further government actions based on the study findings.
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