TY - JOUR
T1 - Comparing Receipt of Prescribed Post-acute Home Health Care Between Medicare Advantage and Traditional Medicare Beneficiaries
T2 - an Observational Study
AU - Loomer, Lacey
AU - Kosar, Cyrus M.
AU - Meyers, David J.
AU - Thomas, Kali S.
N1 - Publisher Copyright:
© 2020, Society of General Internal Medicine.
PY - 2021/8
Y1 - 2021/8
N2 - Background: Medicare Advantage (MA) covers more than 1/3rd of all Medicare beneficiaries. MA plans are required to provide the same benefits as Traditional Medicare (TM), but can impose utilization management tools to control costs. Objective: To assess differences between TM and MA enrollees in the probability of receiving prescribed post-acute home health (HH) care and to describe MA plan characteristics associated with HH receipt. Design: Retrospective cross-sectional analysis of claims data, HH patient assessment data, and MA plan data from 2011 to 2017. Participants: Medicare beneficiaries aged 66 and older with an incident hospitalization for joint replacement, pneumonia, chronic obstructive pulmonary disease, stroke, urinary tract infection, septicemia, acute renal failure, or congestive heart failure. Main Measures: Receipt of prescribed HH as indicated by a HH discharge code and corresponding HH patient assessment within 14 days of hospital discharge. Key Results: There were 2,723,245 beneficiaries prescribed HH at discharge (68% TM, 32% MA). About 75% of TM enrollees and 62% of MA enrollees received prescribed post-acute HH. In adjusted analyses, MA enrollees had an −11.7 percentage point (pp) (95% confidence interval (CI): −16.8, −6.5) lower probability of receiving HH compared with TM enrollees. In adjusted analyses, HMO enrollees in plans with cost sharing (− 8.4 pp; 95% CI: − 14.3, − 2.5), referrals (− 3.7 pp; 95% CI: − 6.1, − 1.2), and pre-authorization (− 5.1 pp; 95% CI: − 8.3, − 2.0) were less likely to receive prescribed HH. In adjusted analyses, PPO enrollees in plans with cost sharing were −7.0 pp (95% CI: − 12.7, − 1.4) less likely to receive HH, but there was no difference for those with referrals (1.1 pp; 95% CI, − 1.5, 3.7) or pre-authorization (1.6 pp; 95% CI: − 0.6, − 3.9). Conclusions: Among Medicare beneficiaries, MA enrollees were less likely to receive prescribed post-acute HH compared with TM. As enrollment in MA continues to grow, it is important to examine how differences in utilization relate to outcomes.
AB - Background: Medicare Advantage (MA) covers more than 1/3rd of all Medicare beneficiaries. MA plans are required to provide the same benefits as Traditional Medicare (TM), but can impose utilization management tools to control costs. Objective: To assess differences between TM and MA enrollees in the probability of receiving prescribed post-acute home health (HH) care and to describe MA plan characteristics associated with HH receipt. Design: Retrospective cross-sectional analysis of claims data, HH patient assessment data, and MA plan data from 2011 to 2017. Participants: Medicare beneficiaries aged 66 and older with an incident hospitalization for joint replacement, pneumonia, chronic obstructive pulmonary disease, stroke, urinary tract infection, septicemia, acute renal failure, or congestive heart failure. Main Measures: Receipt of prescribed HH as indicated by a HH discharge code and corresponding HH patient assessment within 14 days of hospital discharge. Key Results: There were 2,723,245 beneficiaries prescribed HH at discharge (68% TM, 32% MA). About 75% of TM enrollees and 62% of MA enrollees received prescribed post-acute HH. In adjusted analyses, MA enrollees had an −11.7 percentage point (pp) (95% confidence interval (CI): −16.8, −6.5) lower probability of receiving HH compared with TM enrollees. In adjusted analyses, HMO enrollees in plans with cost sharing (− 8.4 pp; 95% CI: − 14.3, − 2.5), referrals (− 3.7 pp; 95% CI: − 6.1, − 1.2), and pre-authorization (− 5.1 pp; 95% CI: − 8.3, − 2.0) were less likely to receive prescribed HH. In adjusted analyses, PPO enrollees in plans with cost sharing were −7.0 pp (95% CI: − 12.7, − 1.4) less likely to receive HH, but there was no difference for those with referrals (1.1 pp; 95% CI, − 1.5, 3.7) or pre-authorization (1.6 pp; 95% CI: − 0.6, − 3.9). Conclusions: Among Medicare beneficiaries, MA enrollees were less likely to receive prescribed post-acute HH compared with TM. As enrollment in MA continues to grow, it is important to examine how differences in utilization relate to outcomes.
KW - Medicare Advantage
KW - home care
KW - home health
KW - managed care
KW - post-acute care
UR - http://www.scopus.com/inward/record.url?scp=85092488577&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85092488577&partnerID=8YFLogxK
U2 - 10.1007/s11606-020-06282-3
DO - 10.1007/s11606-020-06282-3
M3 - Article
C2 - 33051838
AN - SCOPUS:85092488577
SN - 0884-8734
VL - 36
SP - 2323
EP - 2331
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 8
ER -