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Medicare Advantage Patients Have Higher Readmission Rates

FRIDAY, June 28, 2019 -- Medicare Advantage patients have higher risk-adjusted hospital readmission rates than traditional Medicare patients for acute myocardial infarction, congestive heart failure, and pneumonia, according to a new study published online June 24 in the Annals of Internal Medicine.

Orestis A. Panagiotou, M.D., Ph.D., of the Brown University School of Public Health in Providence, Rhode Island, and colleagues used Medicare Provider Analysis and Review (MedPAR) files to identify hospital admissions for traditional Medicare and Medicare Advantage patients as well as Healthcare Effectiveness Data and Information Set (HEDIS) records for hospitals that do not report Medicare Advantage data to MedPAR. The researchers examined the 30-day readmission rate in 4.3 million patients at 4,748 hospitals.

The researchers found that while unadjusted readmission rates were lower in Medicare Advantage patients than traditional Medicare patients, after risk adjustment, patients in Medicare Advantage had higher readmission rates for acute myocardial infarction (17.2 versus 16.9 percent), congestive heart failure (21.7 versus 21.4 percent), and pneumonia (16.5 versus 16 percent). The rate differences also increased between 2011 and 2014.

"The gold-standard design would involve random assignment to Medicare Advantage (for example, in a limited set of geographic markets)," the authors write. "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."

One author disclosed ties to HCR ManorCare and naviHealth.

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Posted: June 2019

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