In the Journals

Post-acute care spending higher among Medicare beneficiaries vs. commercially insured patients

Photo of Scott E. Regenbogen
Scott E. Regenbogen

Spending on post-acute care for multiple medical and surgical conditions was 68% to 230% higher among Medicare beneficiaries compared with commercially insured patients, although readmission rates were similar in both groups, according to study findings published in Health Affairs.

“These findings imply that the differences in use are more likely driven by reimbursement policy than by clinical need, and that there may be real opportunity to reduce clinically unwarranted variation in post-acute care spending in Medicare,” Scott E. Regenbogen, MD, MPH, associate professor of surgery at the University of Michigan, told Healio Primary Care.

Researchers compared post-acute spending between patients insured by Blue Cross Blue Shield of Michigan and Medicare beneficiaries using data from a statewide consortium that included 76 acute care hospitals.

In the study, commercially insured patients were aged 60 to 64 years, and Medicare fee-for-service beneficiaries were aged 65 to 69 years. The patients were hospitalized for six conditions and surgical procedures that are common for their age group: acute myocardial infarction, congestive heart failure, stroke, coronary artery bypass grafting, total hip replacement, and colectomy.

A total of 25,628 patients were included in the study. Compared with commercially insured patients, Medicare beneficiaries had significantly more spending for all but one condition — stroke — and for all forms of post-acute care.

During the study period, spending on post-acute care for hip replacements among Medicare beneficiaries was more than double that spent among commercially insured patients who underwent the same procedure. Spending for post-acute care for heart bypass surgery was approximately two-thirds higher among Medicare patients compared with commercially insured patients.

Researchers noted that despite the substantial difference in spending, there was no significant difference in the 90-day hospital readmission rates between Medicare beneficiaries and commercially insured patients.

Regenbogen told Healio Primary Care that they found the prevalence of patients who received post-acute care was similar in both groups, meaning the difference in spending was attributed to Medicare patients receiving more services during post-acute care.

“Hospital providers need to carefully scrutinize the need for post-acute care and make judicious use of services when needed,” Regenbogen said.

“In the State of Michigan, through work with our Collaborative Quality Initiatives, including the Michigan Value Collaborative and Michigan Arthroplasty Registry Collaborative Quality Initiative, we have worked to reduce clinically unnecessary use of inpatient post-acute care and have seen dramatic reductions in spending on post-acute care without exacerbating readmissions,” he continued.

The data from these initiatives have been submitted for publication, Regenbogen said. – by Erin Michael

Disclosures: Regenbogen is supported by the National Institute on Aging Mentored Career Development Award K08-AG047252 and receives salary support through a contract from Blue Cross Blue Shield of Michigan, for the conduct of the Michigan Value Collaborative. None of the funding agencies were involved in the analysis or interpretation of the data, nor in the composition, critical review, or editing of the manuscript. Please see study for all other authors’ relevant financial disclosures.

Photo of Scott E. Regenbogen
Scott E. Regenbogen

Spending on post-acute care for multiple medical and surgical conditions was 68% to 230% higher among Medicare beneficiaries compared with commercially insured patients, although readmission rates were similar in both groups, according to study findings published in Health Affairs.

“These findings imply that the differences in use are more likely driven by reimbursement policy than by clinical need, and that there may be real opportunity to reduce clinically unwarranted variation in post-acute care spending in Medicare,” Scott E. Regenbogen, MD, MPH, associate professor of surgery at the University of Michigan, told Healio Primary Care.

Researchers compared post-acute spending between patients insured by Blue Cross Blue Shield of Michigan and Medicare beneficiaries using data from a statewide consortium that included 76 acute care hospitals.

In the study, commercially insured patients were aged 60 to 64 years, and Medicare fee-for-service beneficiaries were aged 65 to 69 years. The patients were hospitalized for six conditions and surgical procedures that are common for their age group: acute myocardial infarction, congestive heart failure, stroke, coronary artery bypass grafting, total hip replacement, and colectomy.

A total of 25,628 patients were included in the study. Compared with commercially insured patients, Medicare beneficiaries had significantly more spending for all but one condition — stroke — and for all forms of post-acute care.

During the study period, spending on post-acute care for hip replacements among Medicare beneficiaries was more than double that spent among commercially insured patients who underwent the same procedure. Spending for post-acute care for heart bypass surgery was approximately two-thirds higher among Medicare patients compared with commercially insured patients.

Researchers noted that despite the substantial difference in spending, there was no significant difference in the 90-day hospital readmission rates between Medicare beneficiaries and commercially insured patients.

Regenbogen told Healio Primary Care that they found the prevalence of patients who received post-acute care was similar in both groups, meaning the difference in spending was attributed to Medicare patients receiving more services during post-acute care.

“Hospital providers need to carefully scrutinize the need for post-acute care and make judicious use of services when needed,” Regenbogen said.

“In the State of Michigan, through work with our Collaborative Quality Initiatives, including the Michigan Value Collaborative and Michigan Arthroplasty Registry Collaborative Quality Initiative, we have worked to reduce clinically unnecessary use of inpatient post-acute care and have seen dramatic reductions in spending on post-acute care without exacerbating readmissions,” he continued.

The data from these initiatives have been submitted for publication, Regenbogen said. – by Erin Michael

Disclosures: Regenbogen is supported by the National Institute on Aging Mentored Career Development Award K08-AG047252 and receives salary support through a contract from Blue Cross Blue Shield of Michigan, for the conduct of the Michigan Value Collaborative. None of the funding agencies were involved in the analysis or interpretation of the data, nor in the composition, critical review, or editing of the manuscript. Please see study for all other authors’ relevant financial disclosures.