Key result
Medicare Advantage beneficiaries had higher risk-adjusted 30-day readmission rates than traditional Medicare beneficiaries for AMI (17.2% vs 16.9%), CHF (21.7% vs 21.4%), and pneumonia (16.5% vs 16.0%).
Why the study?
Medicare's Hospital Readmissions Reduction Program reports risk-standardized readmission rates for traditional Medicare but not Medicare Advantage beneficiaries.
Does Medicare Advantage enrollment reduce 30-day readmissions compared to traditional Medicare in older adults hospitalized for AMI, CHF, or pneumonia?
Cohort (n=4,320,630)
Yes
Does Medicare Advantage enrollment reduce 30-day readmissions compared to traditional Medicare in older adults hospitalized for AMI, CHF, or pneumonia?
Risk-adjusted 30-day readmission rates for AMI, CHF, and pneumonia are slightly higher among Medicare Advantage beneficiaries compared to those in traditional Medicare.
Answers are grounded in this paper and cite their sources.
Higher readmission rates in Medicare Advantage merit monitoring; leaves open causal effects of plan type versus selection.
Background: Medicare's Hospital Readmissions Reduction Program reports risk-standardized readmission rates for traditional Medicare but not Medicare Advantage beneficiaries. Objective: To compare readmission rates between Medicare Advantage and traditional Medicare. Design: Retrospective cohort study linking the Medicare Provider Analysis and Review (MedPAR) file with the Healthcare Effectiveness Data and Information Set (HEDIS). Setting: 4748 U.S. acute care hospitals. Patients: Patients aged 65 years or older hospitalized for acute myocardial infarction (AMI) (n = 841 613), congestive heart failure (CHF) (n = 1 458 652), or pneumonia (n = 2 020 365) between 2011 and 2014. Measurements: 30-day readmissions. Results: Among admissions for AMI, CHF, and pneumonia identified in MedPAR, 29.2%, 38.0%, and 37.2%, respectively, did not have a corresponding record in HEDIS. Of these, 18.9% for AMI, 23.7% for CHF, and 18.3% for pneumonia resulted in a readmission that was identified in MedPAR. However, among index admissions appearing in HEDIS, 14.4% for AMI, 18.4% for CHF, and 13.9% for pneumonia resulted in a readmission. Patients in Medicare Advantage had lower unadjusted readmission rates than those in traditional Medicare for all 3 conditions (16.6% vs. 17.1% for AMI, 21.4% vs. 21.7% for CHF, and 16.3% vs. 16.4% for pneumonia). However, after standardization, patients in Medicare Advantage had higher readmission rates than patients in traditional Medicare for AMI (17.2% vs. 16.9%; difference, 0.3 percentage point [95% CI, 0.1 to 0.5 percentage point]), CHF (21.7% vs. 21.4%; difference, 0.3 percentage point [CI, 0.2 to 0.5 percentage point]), and pneumonia (16.5% vs. 16.0%; difference, 0.5 percentage point [95% CI, 0.4 to 0.6 percentage point]). Rate differences increased between 2011 and 2014. Limitation: Potential unobserved differences between populations. Conclusion: The HEDIS data underreported hospital admissions for 3 common medical conditions, and readmission rates were higher among patients with underreported admissions. Medicare Advantage beneficiaries had higher risk-adjusted 30-day readmission rates than traditional Medicare beneficiaries. Primary Funding Source: National Institute on Aging.
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Panagiotou et al. (2019) conducted a cohort in Acute myocardial infarction, congestive heart failure, or pneumonia (n=4,320,630). Medicare Advantage vs. Traditional Medicare was evaluated on Risk-standardized 30-day readmission for acute myocardial infarction (Difference 0.3 percentage points, 95% CI 0.1 to 0.5). Medicare Advantage beneficiaries had higher risk-adjusted 30-day readmission rates than traditional Medicare beneficiaries for AMI (17.2% vs 16.9%), CHF (21.7% vs 21.4%), and pneumonia (16.5% vs 16.0%).
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