Medicare Advantage Stroke Patients Are More Likely to End Up in Low-Quality Nursing Homes, Study Finds

A new study published in JAMA Network Open paints a troubling picture for stroke survivors enrolled in Medicare Advantage plans — they’re significantly more likely to wind up in low-rated skilled nursing facilities than patients on traditional Medicare.

The findings add fresh fuel to a long-running debate over whether cost-cutting incentives baked into MA plans come at the expense of patient outcomes, particularly during the critical early stages of stroke recovery.

The Numbers Tell the Story

Researchers analyzed data from more than 44,000 Medicare beneficiaries aged 65 and older who were hospitalized for a stroke between January 2021 and September 2022. They tracked where patients went after discharge — whether to inpatient rehabilitation, a skilled nursing facility, or home health — and measured the quality of those settings using CMS star ratings.

Among dual-eligible patients enrolled in MA plans, 58.3% were discharged to low-quality SNFs. Compare that with traditional Medicare patients who weren’t dual-eligible: just 42% ended up in low-rated facilities. That’s a 16-point gap — and it’s not random.

“These differences in quality of SNF care can be associated with health outcomes during the initial phases of stroke, particularly functional recovery, and prevention of infections, pressure ulcers, and hospital readmissions,” the study’s authors wrote.

Why It Matters for SNF Operators

The study hits at a core tension in post-acute care. MA plans are built to manage costs, which often means steering patients toward less expensive facilities. But cheaper doesn’t always mean adequate — and for stroke patients, the quality of early rehab can shape long-term outcomes.

Of the full cohort, roughly 37% were discharged to SNFs, 39% to inpatient rehab, and 24% to home health agencies. The disparity in SNF quality was sharpest among dual-eligible MA enrollees, a population that already faces higher barriers to accessing care.

A Growing Pressure Point

The research lands at a moment when policymakers and industry groups are rethinking how Medicare Advantage interacts with post-acute providers. Advocacy organizations have pushed for greater transparency around MA plan discharge patterns, arguing that narrow network designs limit where patients can receive rehab.

For skilled nursing operators, the takeaway is blunt: the facilities absorbing MA and dual-eligible stroke patients tend to have lower ratings. Whether that’s a cause or effect of reimbursement pressure, it’s a pattern that regulators and providers won’t be able to ignore much longer.