Medicare Advantage Enrollees More Likely To Enter Lower-Quality Nursing Homes Compared To Fee-For-Service Enrollees

Meyers, David J.; Mor, Vincent; Rahman, Momotazur

doi:10.1377/hlthaff.2017.0714

Cited by 64 publications

(72 citation statements)

References 33 publications

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“…Medicare Advantage plans may restrict the hospitals available to patients in their networks,9 leading to both the highestand lowest-quality hospitals being less likely to be included in networks. A similar trend has been found for skilled nursing facilities 3. If higher-quality hospitals demand higher reimbursement rates, MA plans may avoid contracting with such hospitals, thereby excluding them from the network.…”

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confidence: 66%

Comparison of the Quality of Hospitals That Admit Medicare Advantage Patients vs Traditional Medicare Patients

et al. 2020

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IMPORTANCE In the Medicare Advantage (MA) program, Medicare enrollees may be steered by their health plan to specific hospitals. Little is known about the quality of hospitals that serve MA enrollees. OBJECTIVE To compare the quality of hospitals that admit MA enrollees with the quality of those that admit traditional Medicare enrollees. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the 2012 to 2016 Medicare Provider Analysis and Review to compare quality of care, as measured by the star rating given by the Centers for Medicare and Medicaid Services and readmission rates, in hospitals that serve MA enrollees and traditional Medicare enrollees using multinomial logit models. Participants were 7 130 610 Medicare beneficiaries admitted to 2994 acute care hospitals across the United States in 2016. Data were analyzed between August 2018 and August 2019. EXPOSURES The exposure was MA enrollment. Adjusters included demographic and clinical characteristics and zip code fixed effects. MAIN OUTCOMES AND MEASURES Hospital Compare star ratings and quintiles of performance in 30-day readmission rates. RESULTS The sample included 7 130 610 Medicare beneficiaries in 2016 (54.3% female; mean [SD] age, 72.7 [13.2] years). Of 12 190 270 total hospitalizations, 1 211 293 traditional Medicare and 494 352 MA patients were admitted to 718 low-readmission hospitals and 1 205 586 traditional Medicare and 526 955 MA patients were admitted to 597 high-readmission hospitals. Accounting for observed patient characteristics, MA enrollees less often entered either low-or high-quality hospitals and were more often admitted to average-quality hospitals. For nonemergent hospitalizations, MA enrollees were 1.9 percentage points (95% CI, 1.5-2.2 percentage points) less likely to enter a low-readmissions hospital, 5.1 percentage points (95% CI, 4.6-5.6 percentage points) more likely to enter an average-readmissions hospital, and 3.2 percentage points (95% CI, 2.9-3.5 percentage points) less likely to enter a high-readmissions hospital compared with traditional Medicare enrollees. Patients with MA were also 2.6 percentage points (95% CI, 2.2-2.9 percentage points) less likely to enter a 1-to 2-star hospital, 5.5 percentage points (95% CI, 4.9-5.9 percentage points) more likely to enter a 3-star hospital, and 2.8 percentage points (95% CI, 2.5-3.2 percentage points) less likely to enter a 4-to 5-star hospital compared with traditional Medicare enrollees. The differences were less pronounced for emergency admissions.

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confidence: 66%

Comparison of the Quality of Hospitals That Admit Medicare Advantage Patients vs Traditional Medicare Patients

et al. 2020

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“…It is of policy interest that there does not appear to be any impact on patient health outcomes. Previous work has found that beneficiaries enrolled in MA contracts tend to enter lower quality nursing homes than those in FFS (Meyers, Mor, and Rahman ) as measured by both readmissions rates, and nursing home compare star ratings. Other work has also found that these star ratings and readmissions rates are related to patient health outcomes.…”

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confidence: 98%

“…The concentration of a particular MA contract in a given SNF is determined by the admissions of FFS patients and MA patients from different plans along with patients’ length of stay and switching between Medicare plans. For instance, Meyers, Mor, and Rahman () found that MA enrollees are receiving care in lower quality of SNFs implying that higher MA concentration may reflect lower quality care. To address this in part, we include SNF characteristics, including the overall share of MA and star rating in our model; however, contract‐specific concentration may still capture unobserved SNF quality.…”

Section: Methodsmentioning

confidence: 99%

“…). MA enrollees appear to be admitted to lower quality SNFs, based upon Medicare's 5‐star rating system, than is the case for FFS beneficiaries from the same residential neighborhoods (Meyers, Mor, and Rahman ). On the other hand, several studies have reported that MA patients receiving SNF care experienced better outcomes than their FFS counterparts, including lower rates of hospital readmission and higher rates of return to the community (Huckfeldt et al.…”

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The Effects of Medicare Advantage Contract Concentration on Patients’ Nursing Home Outcomes

Rahman

Meyers

Mor

2018

Health Services Research

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Objective The Medicare Modernization Act of 2004 allowed Medicare Advantage (MA) contracts to form provider networks in order to concentrate their patients among preferred providers. We focus on the skilled nursing facility (SNF) industry to assess patients’ health when treating SNFs concentrate more patients from the same MA contract. Data Sources/Study Setting We use Medicare Beneficiary Summary File and Health, HEDIS, and the Minimum Data Set for patient attributes and OSCAR, LTCfocus.org, and Nursing Home Compare for SNF attributes. We include 1,069,436 MA enrollees newly admitted to SNF between 2012 and 2014. Study Design Using a MA contract fixed‐effect model, we examine the effect of prevalence of a patient's MA contract in the treating SNF on patient's health outcomes including 180‐day survival, 30‐day hospital readmission, 30‐day home discharge, and nursing home length of stay. We use an Instrumental Variable (IV), the expected share of admissions in a SNF from patient's MA contract calculated using a McFadden choice model. Principal Findings We find no relationship between SNF contract concentration and patients’ outcomes after applying the IV. Conclusions While MA plans appear to steer patients to specific SNFs, we do not observe significant returns to patient outcomes related to concentration.

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“…Prior work found that MA plan enrollees received less intense post‐acute care from a smaller number of SNFs, with lower rates of hospital readmission and higher rates of return to the community . However, there is also evidence that the SNFs used by MA enrollees are of lower quality than those used by traditional fee‐for‐service Medicare patients . Moreover, MA enrollees using SNFs or home health care were more likely to switch back to traditional Medicare the next year, potentially signaling dissatisfaction with the quality of care .…”

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confidence: 99%

Preferred Post‐Acute Care Providers in Bundled Payment: Implications for Patient Choice

Huckfeldt

Weissblum

2019

J American Geriatrics Society

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Medicare Advantage Enrollees More Likely To Enter Lower-Quality Nursing Homes Compared To Fee-For-Service Enrollees

Cited by 64 publications

References 33 publications

Comparison of the Quality of Hospitals That Admit Medicare Advantage Patients vs Traditional Medicare Patients

Comparison of the Quality of Hospitals That Admit Medicare Advantage Patients vs Traditional Medicare Patients

The Effects of Medicare Advantage Contract Concentration on Patients’ Nursing Home Outcomes

Preferred Post‐Acute Care Providers in Bundled Payment: Implications for Patient Choice

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