Inappropriate Utilization in Fee-for-Service Medicare and Medicare Advantage Plans

Shriram Parashuram, Seung Kim, Bryan Dowd

Research output: Contribution to journalArticlepeer-review

Abstract

This study uses a national multi-payer claims database to test for differences in potentially inappropriate emergency department (ED) visits and ambulatory care sensitive (ACS) admissions in fee-for-service (FFS) Medicare and Medicare Advantage (MA) plans. Rates of ACS admissions for MA enrollees were approximately one third those of FFS beneficiaries, controlling for covariates, which included the beneficiary’s health status as represented by their risk score. This study then compared FFS and MA beneficiaries when they moved from one type of health plan to another. Again, controlling for covariates, potentially inappropriate ED visits and ACS admissions remained at their low baseline values for FFS beneficiaries who switched from FFS Medicare to MA plans, but rose for MA enrollees switching to FFS Medicare.

Original languageEnglish (US)
Pages (from-to)58-64
Number of pages7
JournalAmerican Journal of Medical Quality
Volume33
Issue number1
DOIs
StatePublished - Jan 1 2018

Bibliographical note

Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Department of Health and Human Services Office of the Secretary, Assistant Secretary for Planning and Evaluation (ASPE) GSA Contract GS-23F-0058T, ARC Order No. HHSP233-2010-00615G. This research was funded, in part, by the Medica Research Institute.

Keywords

  • ACS admissions
  • ED visits
  • Medicare
  • Medicare Advantage
  • inappropriate utilization

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