Medicare Advantage Reimbursement Structures Impact Home Health Delivery and Outcomes

AJMC November 6, 2025
Rachel A. Prusynski, DPT, PhD, Anthony D’Alonzo, DPT, MBA, Michael P. Johnson, PhD, PT, Jamie M. Smith, PhD, RN, Tracy M. Mroz, PhD, OTR/L

Key Takeaways

Medicare Advantage plans that place greater restrictions on home health agency care delivery may have more adverse patient outcomes than plans that provide episodic payments.

ABSTRACT

Objectives: Medicare Advantage (MA) plans provide fewer home health (HH) services than traditional Medicare (TM), but MA plans vary in how they reimburse HH agencies. Like TM, episodic MA plans allow agencies to determine the number and type of visits. Alternatively, per-visit MA plans dictate a specific number of visits and which disciplines provide them. This study examined differences in HH care delivery and patient outcomes among TM, episodic MA, and per-visit MA plans.

Study Design: Secondary analysis of HH agency data from January 2019 to December 2022.

Methods: For 285,297 HH...

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