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Study Questioned on Medicare Advantage Hospital Readmission Rates

August 22, 2019

Hospital readmission rates for enrollees in Medicare Advantage (MA) are slightly higher than for those in traditional, fee-for-service Medicare plans, a new study published in the Annals of Internal Medicine reports.

The differences are very small, and the new study’s methodology raises questions, says John Goodman, president of the Goodman Institute for Public Policy Research, author of nine books on health policy, and a proponent of MA.

Researchers reviewed the hospitalization records for 4.3 million Medicare patients between 2011 and 2014 and found for acute myocardial infarction, MA had a 17.2 percent readmission rate, compared to 16.9 percent for those in traditional Medicare. For congestive heart failure, the difference was 21.7 percent for MA versus 21.4 percent, and the split was 16.5 percent to 16 percent for pneumonia.

“The differences are small, and they could easily be the result of differences in patient conditions,” Goodman said. “To make a fair comparison, you have to adjust for differences in the patients’ age, severity of condition, and other complicating medical conditions.”

Questions About Methodology

The authors of the Annalsstudy acknowledge their results differ from previous studies comparing readmission rates between MA and traditional Medicare, and they suggest the earlier studies may have used incomplete data.

Of two studies published in 2017 and 2018 in the Journal of the American Medical Association,one found post-discharge mortality rates were higher and the other found no impact on readmission or mortality.

Goodman says there could be another explanation for the differing results.

“Not all MA programs are alike,” said Goodman. “The best MA programs have hospitalists who look after patients in the hospital and are not influenced by the hospital’s economic incentives to release patients too soon. These plans also give patients continuing care after release to prevent readmissions.”

The researchers also acknowledge they relied on information from multiple data sets, which Goodman says is problematic.

“When you are drawing from different data sources, it’s hard to make sure you are comparing apples to apples instead of apples to oranges,” said Goodman.

Measuring Quality

Medicare Advantage is an optional program run by private insurance companies. Unlike traditional fee-for-service, the plans offer integrated care for a fixed monthly fee.

The Center for Medicare and Medicaid Services (CMS) uses 30-day hospital readmission rates to measure quality of care. The Affordable Care Act established the Hospital Readmissions Reduction Program and mandates a penalty system for excessive readmissions. The program considers readmission rates for six conditions, including chronic obstructive pulmonary disease, coronary artery bypass graft surgery, and elective hip and knee replacement, in addition to those mentioned above.

AnneMarie Schieber (amschieber@heartland.org) is managing editor of Health Care News.

Author
AnneMarie Schieber is a research fellow at The Heartland Institute and managing editor of Health Care News, Heartland's monthly newspaper for health care reform.
amschieber@heartland.org @HCPolicy