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Post-acute Care and MA Enrollees

By July 5, 2018Commentary

Medicare Advantage continues to add 2-3% of the beneficiary population as enrollees every year.  It seems very likely that within ten years at the most, over half the program will be in MA plans.  So interest is high in understanding comparative quality and costs in the MA and fee-for-service branches.  A new study carried by the Public Library of Science compares post-acute care outcomes for hip fracture patients who went to a skilled nursing facility following their hospital stay.   (PLOS Article)   Patients were identified for the period January 1, 2011 through December 31, 2015.  The primary outcomes were skilled nursing facility length of stay, rehabilitation therapy minutes per day, 30-day readmissions, changes in functional status, the likelihood of becoming a long-term SNF resident and successful discharge to the community.  Almost 300,000 patients were included in the study.

In general, Medicare Advantage enrollees were younger and less cognitively impaired than were FFS beneficiaries and were more likely to be African-American, Hispanic, married and dually eligible for Medicare. After adjusting for these and other factors, the Medicare Advantage members had 5.1 fewer days in a skilled nursing facility, 463 fewer total rehabilitation minutes in the first 40 days of their stay, or 12.1 fewer per day; 1.2% lower rate of 30-day hospital readmissions, .6% less chance of becoming a long-term SNF resident and a 3.2% higher rate of successful discharge to the community.  A number of things might be learned from the study.  One is that on the FFS side SNFs are incented to create longer lengths of stay and deliver more rehabilitation therapy services, because they get paid more when this occurs.  Those incentives likely are removed by MA plans, who also probably are using narrower networks of facilities and case management techniques to monitor care.  Those extra days and extra rehab services on the FFS side seem to make little difference in quality related outcomes, in fact, they seem to be associated with worse outcomes.  This study adds to a growing body of research finding lower spending and as good or better quality among MA plans.  It is pretty obvious that CMS and Congress would be well-advised to do whatever they can to accelerate enrollment in Medicare Advantage.

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