title: Differences in Nursing Home Quality Between Medicare Advantage and Traditional Medicare Patients.
abstract: Medicare Advantage (MA) enrollment is steadily growing, but little is known about the quality of nursing home (NH) care provided to MA enrollees compared to enrollees in traditional fee-for-service (FFS) Medicare.
  
  
  
  To compare MA and FFS enrollees' quality of NH care.
  
  
  
  Cross-sectional.
  
  
  
  US nursing homes.
  
  
  
  2.17 million Medicare enrollees receiving care at an NH during 2011.
  
  
  
  CMS methodology was used to calculate the 18 Nursing Home Compare quality measures as applicable for each enrollee.
  
  
  
  Among Medicare enrollees using NH in 2011, 17% were in MA plans. Most quality scores were similar between MA and FFS. After adjusting for facility, beneficiary age and gender, CMS Hierarchical Condition Category score, and geographic region, short-stay MA enrollees had statistically significantly lower rates of new or worsening pressure ulcers [relative risk (RR) = 0.76, 95% confidence interval (CI) = 0.71-0.82] and new antipsychotic use (RR = 0.82, 95% CI = 0.80-0.83) but higher rates of moderate to severe pain (RR = 1.09, 95% CI = 1.07-1.12), compared with short-stay FFS enrollees. MA long-stay enrollees had lower rates of antipsychotic use (RR = 0.94, 95% CI = 0.93-0.96) but had higher rates of incontinence (RR = 1.08, 95% CI = 1.06-1.09) and urinary catheterization (RR = 1.10, 95% CI = 1.06-1.13), compared with long-stay FFS enrollees.
  
  
  
  Overall, we found few differences in NH quality scores between MA and FFS Medicare enrollees. MA enrollment was associated with better scores for pressure ulcers and antipsychotic use but worse scores for pain control, incontinence, and urinary catheterization. Results may be limited by residual case-mix differences between MA and FFS patients or by the small number of short-stay measures reported.
authors: David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA. Electronic address: emileychang@mednet.ucla.edu.
authors: Emiley
authors: E
authors: Chang
authors: The RAND Corporation, Santa Monica, CA.
authors: Teague
authors: T
authors: Ruder
authors: The RAND Corporation, Santa Monica, CA.
authors: Claude
authors: C
authors: Setodji
authors: David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA; The RAND Corporation, Santa Monica, CA; VA Greater Los Angeles HSR&D Center of Innovation, Sepulveda, CA; Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; Borun Center for Gerontological Research, University of California at Los Angeles and Los Angeles Jewish Home, Los Angeles, CA.
authors: Debra
authors: D
authors: Saliba
authors: The RAND Corporation, Santa Monica, CA.
authors: Mark
authors: M
authors: Hanson
authors: David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA.
authors: David S
authors: DS
authors: Zingmond
authors: David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA; The RAND Corporation, Santa Monica, CA.
authors: Neil S
authors: NS
authors: Wenger
authors: David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA; The RAND Corporation, Santa Monica, CA; VA Greater Los Angeles HSR&D Center of Innovation, Sepulveda, CA; Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA.
authors: David A
authors: DA
authors: Ganz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D020398:Medicare Part C; D009735:Nursing Homes / Q000592:standards*; D014481:United States
keywords: Medicare Advantage; nursing homes; quality measures