Better Quality of Care or Healthier Patients? Hospital Utilization by Medicare Advantage and Fee-for-Service Enrollees

Nicholas, Lauren Hersch

doi:10.1515/fhep-2012-0037

Cited by 18 publications

(10 citation statements)

References 32 publications

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“…21 Moreover, since 2003 both groups have experienced similar declines in overall mortality, lending support to the conclusion that the observed changes among the Fee-for-Service population are not the result of changes in the risks of the groups relative to each other and do represent true improvement. Moreover, other studies have found that healthier people are likely to shift enrollment from Fee-for-Service to Medicare Advantage, which may have led to an underestimation of the improvement over time, 22,23 because we observed increasing enrollment in Medicare Advantage over time.…”

Section: Discussionmentioning

confidence: 60%

Mortality, Hospitalizations, and Expenditures for the Medicare Population Aged 65 Years or Older, 1999-2013

Krumholz

Nuti

Downing

et al. 2015

JAMA

133

102

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In a period of dynamic change in health care technology, delivery, and behaviors, tracking trends in health and health care can provide a perspective on what is being achieved.OBJECTIVE To comprehensively describe national trends in mortality, hospitalizations, and expenditures in the Medicare fee-for-service population between 1999 and 2013. DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional analysis of Medicare beneficiaries aged 65 years or older between 1999 and 2013 using Medicare denominator and inpatient files. MAIN OUTCOMES AND MEASURESFor all Medicare beneficiaries, trends in all-cause mortality; for fee-for-service beneficiaries, trends in all-cause hospitalization and hospitalizationassociated outcomes and expenditures. Geographic variation, stratified by key demographic groups, and changes in the intensity of care for fee-for-service beneficiaries in the last 1, 3, and 6 months of life were also assessed. RESULTSThe sample consisted of 68 374 904 unique Medicare beneficiaries (fee-for-service and Medicare Advantage). All-cause mortality for all Medicare beneficiaries declined from 5.30% in 1999 to 4.45% in 2013 (difference, 0.85 percentage points; 95% CI, 0.83-0.87).

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Section: Discussionmentioning

confidence: 60%

Mortality, Hospitalizations, and Expenditures for the Medicare Population Aged 65 Years or Older, 1999-2013

Krumholz

Nuti

Downing

et al. 2015

JAMA

133

102

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“…Capitated payments create financial incentives for MA plans to reduce hospitalizations, including readmissions, and to lower the intensity of services provided during inpatient stays. MA plans can achieve these goals through managed care tools including care coordination, information sharing, steering patients to lower cost providers in lower intensity settings (Nicholas, 2013), utilization management, and reimbursing hospitals at rates that reflect the value of services, which may be lower than TM rates (Baker, Bundorf, Devlin, & Kessler, 2016). MA plans can also attempt to "cherry-pick" healthier beneficiaries less likely to need inpatient care, although Centers for Medicare & Medicaid Services (CMS) payment adjustments based on enrollee demographics and health status work toward neutralizing this incentive.…”

Section: Introductionmentioning

confidence: 99%

Medicare Advantage and Traditional Medicare Hospitalization Intensity and Readmissions

et al. 2017

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Medicare Advantage plans have incentives and tools to optimize patient care. Therefore, Medicare Advantage hospitalizations may have lower cost and higher quality than similar traditional Medicare hospitalizations. We applied a coarsened matching approach to 2013 Healthcare Cost and Utilization Project hospital discharge data from 22 states to compare hospital cost, length of stay, and readmissions for Traditional Medicare and Medicare Advantage. We found that Medicare Advantage hospitalizations were substantially less expensive and shorter for mental health stays but costlier and longer for injury and surgical stays. We found little difference in the cost and length of medical stays and in readmission rates. One explanation is that Medicare Advantage plans use outpatient settings for many patients with behavioral health conditions and for injury and surgical patients with less complex health needs. Alternatively, the observed differences in behavioral health cost and length of stay may represent skimping on appropriate care.

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“…1 The original proponents of MA saw the potential for improved quality of care, which could lead to better health outcomes when compared with those of FFS Medicare. 2 However, the ability of MA to achieve these goals has not been fully demonstrated. A recent systematic review published by the Kaiser Family Foundation described the evidence regarding the relative impact of MA on actual objective health outcomes and mortality as outdated and characterized by insufficient control for selection bias.…”

Section: Introductionmentioning

confidence: 99%

Mortality Differences Between Traditional Medicare and Medicare Advantage: A Risk-Adjusted Assessment Using Claims Data

Beveridge

Mendes

Caplan

et al. 2017

INQUIRY

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Medicare Advantage (MA) has grown rapidly since the Affordable Care Act; nearly one-third of Medicare beneficiaries now choose MA. An assessment of the comparative value of the 2 options is confounded by an apparent selection bias favoring MA, as reflected in mortality differences. Previous assessments have been hampered by lack of access to claims diagnosis data for the MA population. An indirect comparison of mortality as an outcome variable was conducted by modeling mortality on a traditional fee-for-service (FFS) Medicare data set, applying the model to an MA data set, and then evaluating the ratio of actual-to-predicted mortality in the MA data set. The mortality model adjusted for clinical conditions and demographic factors. Model development considered the effect of potentially greater coding intensity in the MA population. Further analysis calculated ratios for subpopulations. Predicted, risk-adjusted mortality was lower in the MA population than in FFS Medicare. However, the ratio of actual-to-predicted mortality (0.80) suggested that the individuals in the MA data set were less likely to die than would be predicted had those individuals been enrolled in FFS Medicare. Differences between actual and predicted mortality were particularly pronounced in low income (dual eligibility), nonwhite race, high morbidity, and Health Maintenance Organization (HMO) subgroups. After controlling for baseline clinical risk as represented by claims diagnosis data, mortality differences favoring MA over FFS Medicare persisted, particularly in vulnerable subgroups and HMO plans. These findings suggest that differences in morbidity do not fully explain differences in mortality between the 2 programs.

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Better Quality of Care or Healthier Patients? Hospital Utilization by Medicare Advantage and Fee-for-Service Enrollees

Cited by 18 publications

References 32 publications

Mortality, Hospitalizations, and Expenditures for the Medicare Population Aged 65 Years or Older, 1999-2013

Mortality, Hospitalizations, and Expenditures for the Medicare Population Aged 65 Years or Older, 1999-2013

Medicare Advantage and Traditional Medicare Hospitalization Intensity and Readmissions

Mortality Differences Between Traditional Medicare and Medicare Advantage: A Risk-Adjusted Assessment Using Claims Data

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