AHA Blames MA Prior Auth for Stranding Patients in Hospitals

The American Hospital Association is pointing to prior authorization as the reason Medicare Advantage patients get stuck in hospital beds longer than they should. In comments to the Medicare Payment Advisory Commission, the AHA responded to MedPAC's September discussion of post-acute care, according to Becker's Hospital Review.

Preliminary MedPAC findings show MA beneficiaries use less post-acute care, such as skilled nursing and home health, and spend more time in acute care hospitals than their traditional fee-for-service counterparts. The AHA's argument is that MA insurers' approval requirements delay or deny transfers to post-acute settings, leaving patients who are medically ready for discharge waiting in more expensive acute care beds.

In practice, that ties up hospital capacity, raises costs, and can slow care for incoming patients. The dispute adds to mounting scrutiny of MA prior authorization, which regulators and providers have increasingly targeted. MedPAC's findings could shape future policy recommendations on how MA plans manage post-acute transitions.