Medicare Advantage users have higher risk-adjusted 30-day hospital readmission rates compared to traditional Medicare beneficiaries, according to a study released Monday.
The findings countered previous research suggesting readmission rates were lower among MA beneficiaries.
Brown University School of Public Health researchers compared hospital readmissions after the common diagnoses of heart failure, pneumonia and acute myocardial infarction between 2011 and 2014.
Their retrospective analysis of more than five million cases comes as more long-term care operators are joining existing MA plans or forming their own. The plans are increasingly popular among seniors, according to a J.D. Power study released last week. Some 20.4 million Americans are enrolled, with cost the leading reason for participants to switch plans.
J.D. Power, however, reported that opting into MA plans based on cost alone correlated with considerably lower customer satisfaction than rates among those who switch for cost- and non-cost-related reasons. And a previous Brown study found that seniors who needed long-term care were more likely to be steered toward lower quality nursing homes if they joined MA plans.
The new study did not distinguish between patients discharged to nursing homes or to the community after their initial hospital care.
The biggest rehospitalization variation was in those with pneumonia. After adjusting for risk, 16% of traditional patients went back to the hospital, while 16.5% of those with an MA plan did.
“Among hospitals in which both Medicare Advantage and traditional Medicare beneficiaries were admitted, readmission rates were higher for those in Medicare Advantage in 1,098 of 2,138 (51%) after AMI, 1,721 of 3,373 (51%) after CHF and 1,920 of 3,720 hospitals (52%) after pneumonia,” the team reported in the Annals of Internal Medicine.
The Brown researchers said their data set was more comprehensive, accounted for comorbidities and didn’t focus solely on patients who’d been initially discharged to skilled nursing.
“Forty percent of Medicare beneficiaries are projected to be enrolled in Medicare Advantage by 2028,” they wrote. “The Medicare Payment Advisory Commission has estimated payments for Medicare Advantage beneficiaries … are higher than those for comparable traditional Medicare beneficiaries. Therefore, our study suggests the need to track outcomes for patients in both insurance programs using comparable methods, data sources and risk-adjustment approaches.”
