Medicare Advantage Linked to Increased Hospital Length of Stay Post-Pandemic
A recent study published in JAMA Internal Medicine highlights a significant increase in hospital length of stay (LOS) for Medicare Advantage beneficiaries compared to those with traditional Medicare post-COVID-19 pandemic. The disruption in patient flow and care-seeking patterns during the pandemic has led to challenges in discharging clinically stable patients promptly, exacerbated by a reduced supply of skilled nursing facility beds and administrative barriers such as prior authorization requirements and narrow networks inherent to Medicare Advantage plans. These factors have contributed to longer hospital stays, particularly for patients discharged to skilled nursing facilities, indicating operational and financial pressures on healthcare providers and payers.
The study utilized an extensive dataset from the Medicare Provider Analysis and Review combined with Medicare enrollment data spanning 2017 through the third quarter of 2023, analyzing around 89.3 million admissions across 4,075 hospitals. Key outcomes measured included overall length of stay and extended stays defined as admissions exceeding 7, 14, 21, or 28 days. The analysis showed a significant rise in prolonged hospitalizations among Medicare Advantage beneficiaries particularly after 2020, with admissions lasting at least 14 days increasing from 6.7% in 2017 to 8.8% in 2023, as opposed to a smaller rise among traditional Medicare beneficiaries from 5.9% to 6.5%.
Adjusted regression models indicated Medicare Advantage patients were 19.5% more likely to experience hospital stays of at least 14 days by 2023, with even higher increases for stays exceeding 21 and 28 days. This phenomenon was most pronounced in patients discharged to skilled nursing facilities, who saw a 28.1% increase in extended stays compared to traditional Medicare patients. Overall, these extended stays accounted for an estimated 1.8 million additional hospital bed days in 2022, equating to the occupancy generated by roughly 288,000 average-length admissions, underscoring significant resource utilization implications.
The study underscores administrative hurdles linked to Medicare Advantage plans as a critical factor in delayed discharges, amid a constrained post-acute care infrastructure. While the research is observational and limited to Medicare populations, findings suggest increased scrutiny on Medicare Advantage discharge practices and potential policy interventions to streamline prior authorization and network restrictions might mitigate hospital bottlenecks.
As Medicare Advantage enrollment continues to grow, the impact of extended hospital stays poses operational challenges for hospitals and payers alike, influencing capacity management and cost structures. Policymakers are urged to consider strategies addressing discharge inefficiencies to alleviate downstream effects on hospital throughput and patient outcomes. This study contributes valuable empirical evidence about post-pandemic shifts in hospital utilization within Medicare segments, with implications for healthcare delivery and payer strategy.