Limiting the use of health risk assessments in Medicare Advantage could save the federal government billions each year, a study published May 6 in Health Affairs found.
CMS encourages Medicare Advantage plans to conduct annual surveys of patients' health status, known as health risk assessments. These reviews can be used to connect members with additional resources but often add diagnoses to a patient's risk score, according to the study. These reviews inflate payments MA plans receive per member, based on their health risks.
Because of this inflation, the Medicare Payment and Advisory Commission has recommended excluding diagnoses captured in health risk assessments from risk adjustment calculations, according to the study.
Researchers examined data for beneficiaries enrolled in Medicare Advantage in 2019. They found that half of MA beneficiaries had a health risk assessment in that year, and 1 in 5 of those who had an assessment had their risk score inflated based on the diagnoses found in the assessment.
Capping the extent to which health risk assessments can be used in risk scores could save the federal government between $4.5 billion and $12.3 billion each year, the researchers said.
"Although not all HRAs may be used solely for the purpose of coding intensity, our study suggests that some limits on their use for capturing diagnosis codes may be warranted to ensure a level playing field and appropriate stewardship of taxpayer dollars as the MA program continues to expand," the researchers concluded.
The study was conducted by researchers at Brown University in Providence, R.I.
Read the full study here.