Navigating the Impact of a Growing Medicare Advantage Program on Rural Hospitals

In a panel discussion moderated by Aaron Wesolowski, AHA vice president of research strategy and policy communications, John Allison, AHA senior associate director, health policy and analytics; Jeremy Martin, COO of St. James Parish Hospital in Lutcher, La.; and Carl Vaagenes, CEO, Alomere Health, in Alexandria, Minn., reviewed the impacts of certain Medicare Advantage programs on many rural hospitals, as revealed in the AHA’s new report, The Growing Impact of Medicare Advantage on Rural Hospitals Across America.

“It’s changing the way we do business,” Martin said. “Our patients do not understand what they have signed up for. What we’ve learned is that most people thought they had [Traditional] Medicare.” 

The report shows that MA plans have had an over 100% growth in rural areas between 2018-2023 — double the rate of growth in urban hospitals. The major obstacles MA plans bring with them are low rates of reimbursement, administrative and care costs, and lower access to quality care. Each of the hospitals represented by the panelists has experienced each of these.

“The biggest pain point on the back end is the overhead it takes to put the team in place to get around prior authorizations and fighting the denials we receive,” Vaagenes said. 

“Our team works really hard to help the patients navigate their program and make sure that their treatment is going to be covered,” Vaagenes said. “We’re trying to make sure we’re doing the best we can, and it’s one of the things we pride ourselves on.”