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Hospital Quality in MA Plans

By January 22, 2020January 26th, 2020Commentary

Most research has found that Medicare Advantage plans provide better quality of care outcomes for their members than exists for fee-for-service beneficiaries.  This is likely because they are incented with higher payments for better quality, or at least better scores on what passes for CMS’ quality measures.  And it may be partly due to more attention to care coordination and the needs of complex patients.  A new piece of research looks at the comparative quality of hospitals that Medicare Advantage and fee-for-service beneficiaries tend to use.   (JAMA Article)   The analysis was based on over 12 million hospitalizations in 2016 and quality was ascertained based on mortality rates, readmissions and CMS’ stars ratings from 2012 to 2016.  The primary measure they used to categorize hospitals as low, average, or high quality, unfortunately, was the quintile of readmissions into which they fell, with the lowest quintile being low, the middle three average and the highest quintile deemed to be high quality.  The authors main finding was that MA enrollees were 2.8% less likely than traditional beneficiaries to go to a high quality hospital, 5.5% more likely to go to an average quality one and 2.6% less likely to go to a low quality one.  So what looks like a mixed bag, but really tells you nothing, especially about the actual quality of care a beneficiary received.

A couple of things to note.  One is that the Medicare Advantage enrollees were more likely to be non-white and to be poorer, so they don’t likely live in neighborhoods that house the fancy hospitals that tend to get high stars ratings, deserved or not.  It is highly likely that the researchers failed to adequately adjust for health status and needs of beneficiaries, in much the same way as the readmissions measure has been shown to fail to do so.   The “quality” measures used for this study may not really be that.  The readmissions measure has been pretty much debunked as worthless at actually deciphering the level of quality at a hospital.  The stars rating is similarly composed of a bunch of sub-measures that quite often don’t tell you anything about real quality of outcomes in treating beneficiaries.  What would be more meaningful is to look at what happens to the relative health status of Medicare Advantage beneficiaries over the time they are in a plan and what their actual health outcomes look like when they are hospitalized, regardless of the supposed quality categorization of the hospital.  I strongly suspect that MA plans are generally capable of ensuring that beneficiaries get good quality of care no matter what kind of hospital they are in, and save money in the process.

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