Key result
Including Medicare Advantage patients in readmission metrics changes penalty status for ~23% of US hospitals.
Why the study?
Exclusively reporting readmission rates for traditional Medicare beneficiaries under the Hospital Readmissions Reduction Program may not accurately reflect hospitals' readmission rates for older adults.
Does the inclusion of Medicare Advantage patients in calculating risk-standardized readmission rates change hospital performance and penalty status compared to using traditional Medicare patients alone?
Population
TM and MA patients admitted and discharged alive for AMI, CHF, or pneumonia at 4070 US hospitals
Comparison
Inclusion of MA beneficiaries vs TM-only data for calculating 30-day RSRRs and penalty status
Design
Retrospective cohort study
Follow-up
30 days
Authors
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May alter penalty status for 23% of hospitals; leaves open whether Medicare Advantage inclusion improves readmission metric validity.
Cohort (n=5,456,663)
Yes
Does the inclusion of Medicare Advantage patients in calculating risk-standardized readmission rates change hospital performance and penalty status compared to using traditional Medicare patients alone?
Including Medicare Advantage patients in hospital readmission metrics changes the financial penalty status for nearly a quarter of US hospitals, suggesting current traditional Medicare-only metrics may not accurately reflect overall hospital quality.
Panagiotou et al. (2021) conducted a cohort in Acute myocardial infarction, congestive heart failure, or pneumonia (n=5,456,663). Inclusion of Medicare Advantage (MA) patients in readmission measures vs. Traditional Medicare (TM) patients only was evaluated on Readmission for any reason within 30 days after discharge and change in hospital penalty status. Including Medicare Advantage patients in 30-day risk-standardized readmission rate calculations changed the financial penalty status for 23% of US hospitals for at least 1 of 3 conditions.
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