Healio Special Report: Health Care and Politics

Healio Special Report: Health Care and Politics

June 24, 2019
2 min read

Hospital readmissions underreported, higher for Medicare Advantage vs. traditional Medicare

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Medicare Advantage beneficiaries had higher 30-day readmission rates than traditional Medicare beneficiaries, and these admissions may be underreported, according to a study published in the Annals of Internal Medicine.

“One third of Medicare beneficiaries (about 19 million people) are currently enrolled in Medicare Advantage,” Orestis A. Panagiotou, MD, PhD, of Brown University School of Public Health, and colleagues wrote. “Previous studies have reported lower readmission rates in Medicare Advantage than traditional Medicare, leading some policy observers to conclude that Medicare Advantage beneficiaries have better post-acute care outcomes. However, these studies have been limited by the lack of complete and accurate data on hospitalizations in Medicare Advantage.”

Linking data from the Medicare Provider Analysis and Review (MedPAR) file with the Healthcare Effectiveness Data and Information Set (HEDIS), researchers conducted a retrospective cohort study of patients aged 65 years or older who were hospitalized between 2011 and 2014 for acute myocardial infarction (n = 841,613), congestive heart failure (n = 1,458,652) or pneumonia (n = 2,020,365).

The primary outcome of the study was all-cause readmission within 30 days of discharge.

After first reviewing MedPAR, researchers found that 29.2% of patients admitted for acute myocardial infarction, 38% of those hospitalized for congestive heart failure and 37.2% of those hospitalized for pneumonia did not have a corresponding record in HEDIS. In addition, MedPAR documented that 18.9%, 23.7% and 18.3% of these hospitalizations resulted in readmissions for acute myocardial infarction, congestive heart failure and pneumonia, respectively. In contrast, HEDIS recorded readmissions as 14.4%, 18.4% and 13.9% for acute myocardial infarction, congestive heart failure and pneumonia, respectively.

Medicare Advantage beneficiaries had higher 30-day readmission rates than traditional Medicare beneficiaries.
Source: Adobe Stock

Researchers also found that, although Medicare Advantage had lower unadjusted readmission than traditional Medicare for all three conditions, patients in Medicare Advantage had higher readmission rates than patients in traditional Medicare after standardization (acute myocardial infarction: 17.2% vs. 16.9%; congestive heart failure: 21.7% vs. 21.4%; pneumonia: 16.5% vs. 16%).

“Despite underreporting of readmissions in HEDIS data and incomplete ascertainment of readmissions for Medicare Advantage beneficiaries in MedPAR data, we found no evidence that readmission rates for three common medical conditions were higher in traditional Medicare than in Medicare Advantage,” the researchers concluded. “Incorporating outcomes for Medicare Advantage beneficiaries into hospital performance measures would allow for more comprehensive quality assessments.”

In a related editorial, Peter Huckfeldt, PhD, of the University of Minnesota, and Neeraj Sood, PhD, of the University of Southern California, wrote: “On the one hand, the combination of financial incentives and coverage flexibility in Medicare Advantage plans could lead to innovative health care practices that improve patient outcomes. On the other hand, if cost-control incentives dominate other considerations, quality of care and patient outcomes could be worse. Panagiotou and colleagues’ findings imply that [growth in Medicare Advantage enrollment] could adversely affect patient outcomes. More work is needed to establish whether this is a persistent and causal effect of Medicare Advantage enrollment and what mechanisms are driving these differences.” – by Melissa J. Webb

Disclosures: Panagiotou reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.