Medicare Advantage and traditional fee-for-service (FFS) Medicare beneficiaries received similar-quality care during hospitalization with heart failure, except for discharge disposition, a study found.
People covered by the private insurance plan option had higher chances of being discharged directly home (72.8% vs 69.8%, adjusted OR 1.16, 95% CI 1.13-1.19) and marginally lower odds of being discharged within 4 days (adjusted OR 0.97, 95% CI 0.93-1.00).
However, in-hospital mortality rates were similar with Medicare Advantage (MA) and FFS Medicare (2.9% vs 3.0%, adjusted OR 0.98, 95% CI 0.92-1.03), according to researchers led by Jose Figueroa, MD, MPH, of Harvard Medical School and Brigham and Women’s Hospital, reporting online in JAMA Cardiology.
A male doctor and female nurse in a hospital at the bedside of a senior man
Medicare Advantage and traditional fee-for-service (FFS) Medicare beneficiaries received similar-quality care during hospitalization with heart failure, except for discharge disposition, a study found.
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People covered by the private insurance plan option had higher chances of being discharged directly home (72.8% vs 69.8%, adjusted OR 1.16, 95% CI 1.13-1.19) and marginally lower odds of being discharged within 4 days (adjusted OR 0.97, 95% CI 0.93-1.00).
However, in-hospital mortality rates were similar with Medicare Advantage (MA) and FFS Medicare (2.9% vs 3.0%, adjusted OR 0.98, 95% CI 0.92-1.03), according to researchers led by Jose Figueroa, MD, MPH, of Harvard Medical School and Brigham and Women’s Hospital, reporting online in JAMA Cardiology.
“The main influence of MA appears to be limiting the use of post-acute care facilities, which is likely a utilization management strategy aimed at reducing costs,” the authors suggested.
“As MA continues to grow, it will be important to ensure that participating private plans provide an added value to the patients they cover to justify the higher administrative costs compared with traditional FFS Medicare,” they concluded.
The study seems to provide some justification for the greater expense, commented Christopher Tompkins, PhD, of Brandeis University in Waltham, Massachusetts.
He said that the lower use of post-acute care facilities associated with Advantage plans mirrors similar findings from the CMS Bundled Payments for Care Improvement (BPCI) program and may be the result of discharge planning, care coordination, network referral protocols and other added value paid for through administrative budgets.
After all, advance care planning and discharge instructions take time and resources, he noted. “To see such activities occurring differentially within the same hospitals strikes me as a sign of success, albeit modest in magnitude.”
“In spite of my comments, I worry that MA plans are overpaid,” Tompkins added.
“I don’t worry much about damaging effects on quality resulting from tight budgets. If MA were priced by Medicare to be cost-saving rather than cost-increasing, there would be more interest in effects on access and quality,” Tompkins told MedPage Today.
In the study, the two groups came out similar on other measures of heart failure care, namely receipt of guideline-recommended therapies at discharge (e.g., beta-blockers, ACE inhibitors, angiotensin II receptor blockers, or angiotensin receptor-neprilysin inhibitors), measurement of left ventricular function, and postdischarge appointments.
For the observational study, Figueroa’s team drew upon records from hospitals participating in the Get With the Guidelines -Heart Failure registry and found 262,626 Medicare beneficiaries hospitalized with heart failure in 2014-2018.
Medicare Advantage covered 35.6% of patients in the study, the rest were enrolled in a traditional FFS plan.
Median age was 78 for both Medicare Advantage and FFS groups. Women made up roughly half the cohort, and more than 70% of patients were white.
The two groups were not substantially different in baseline characteristics, “unlike earlier reports that show MA plans attract healthier patients,” according to the investigators.
Yet “equivalence among the two cohorts does not obviously generalize to the underlying populations,” Tompkins argued, suggesting it is unclear if disproportionately sicker subgroups presented to the hospital after differential management in the ambulatory setting between Advantage and FFS Medicare.
Study results may not be generalizable to centers not participating in the registry, Figueroa and colleagues also cautioned.
Other limitations included inability to evaluate postdischarge quality metrics (e.g., 30-day mortality and readmissions) or to determine appropriateness of patients’ discharge destinations.
It may be that Medicare Advantage is of different value between inpatient and outpatient care, the investigators suggested.
For example, people with coronary artery disease receiving outpatient cardiology care were more likely to receive evidence-based therapies on Medicare Advantage than on FFS Medicare, Figueroa’s group showed in 2019.
“What could explain the difference in findings in the inpatient vs ambulatory setting? One important reason may be the nature of how MA negotiates contracts with ambulatory clinicians compared with inpatient clinicians,” study authors said.
Unless part of a larger health system, ambulatory clinicians and their practices negotiate directly with Medicare Advantage plans (or an intermediary) and are strongly incentivized the ensure a certain level of care quality, according to Figueroa’s group.
On the other hand, inpatient physicians are often unaware of the specifics of the hospital’s contract with a Medicare Advantage private plan, likely limiting its influence on their practice, they said.
Source: Medpage Today