Medicare Advantage beneficiaries use less post-acute care and stay longer in acute care hospitals than their fee-for-service counterparts, preliminary findings from the Medicare Payment Advisory Commission show, and the American Hospital Association is pointing to prior authorization as the reason.
The AHA sent comments to MedPAC responding to the commission’s September discussion of post-acute care use across the two Medicare populations, according to an Oct. 2 AHA news release. MedPAC found that in 2023, there were 14 inpatient rehabilitation facility stays per 1,000 fee-for-service beneficiaries, compared with 5 per 1,000 MA enrollees. MA beneficiaries also had longer acute care stays, regardless of where they were discharged. The median stay before transfer to an inpatient rehabilitation facility was nine days for MA enrollees versus six for fee-for-service beneficiaries, and before transfer to a long-term care hospital it was 21 days versus 13.
“These patterns are consistent with hospitals’ and health systems’ experiences: MA prior authorization and utilization management practices delay hospital discharge and restrict access to the level of post-acute care recommended by the treating clinical team,” Ashley Thompson, senior vice president of public policy analysis and development for the AHA, wrote in the letter to MedPAC Chair Amol Navathe, MD, PhD.
The AHA said discharge-ready patients occupy acute care beds and clinical resources while plans process authorization requests, peer-to-peer reviews and appeals. The association also said some plans steer patients recommended for inpatient rehabilitation facilities or long-term care hospitals to skilled nursing facilities.
MedPAC’s findings are preliminary. The AHA urged the commission to adjust its comparisons for beneficiary characteristics, examine outcomes tied to different post-acute settings, and measure the time between discharge readiness, prior authorization submission, plan determination and transfer.
Post-acute discharge delays ranked among hospitals’ top challenges in 2025, and federal reviewers have examined MA post-acute care denials. A growing number of health systems have dropped MA plans, citing payment and authorization practices.
Insurers have pledged to streamline prior authorization. Under a CMS rule finalized in 2024, MA plans have had to decide expedited requests within 72 hours and standard requests within seven days since January. The AHA said it appears plans are not following CMS guidance and urged MedPAC to interview discharge planners, clinicians and patients as it continues its work.
