title: Less Intense Postacute Care, Better Outcomes For Enrollees In Medicare Advantage Than Those In Fee-For-Service.
abstract: Traditional fee-for-service (FFS) Medicare's prospective payment systems for postacute care provide little incentive to coordinate care or control costs. In contrast, Medicare Advantage plans pay for postacute care out of monthly capitated payments and thus have stronger incentives to use it efficiently. We compared the use of postacute care in skilled nursing and inpatient rehabilitation facilities by enrollees in Medicare Advantage and FFS Medicare after hospital discharge for three high-volume conditions: lower extremity joint replacement, stroke, and heart failure. After accounting for differences in patient characteristics at discharge, we found lower intensity of postacute care for Medicare Advantage patients compared to FFS Medicare patients discharged from the same hospital, across all three conditions. Medicare Advantage patients also exhibited better outcomes than their FFS Medicare counterparts, including lower rates of hospital readmission and higher rates of return to the community. These findings suggest that payment reforms such as bundling in FFS Medicare may reduce the intensity of postacute care without adversely affecting patient health.
authors.affiliation: Peter J. Huckfeldt (huckfeld@umn.edu) is an assistant professor in the Division of Health Policy and Management, School of Public Health, University of Minnesota, in Minneapolis.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Huckfeldt
authors.affiliation: José J. Escarce is a professor of medicine in the David Geffen School of Medicine, University of California, Los Angeles.
authors.forename: José J
authors.initials: JJ
authors.lastname: Escarce
authors.affiliation: Brendan Rabideau is a research programmer at the Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, in Los Angeles.
authors.forename: Brendan
authors.initials: B
authors.lastname: Rabideau
authors.affiliation: Pinar Karaca-Mandic is an associate professor in the Division of Health Policy and Management, School of Public Health, University of Minnesota.
authors.forename: Pinar
authors.initials: P
authors.lastname: Karaca-Mandic
authors.affiliation: Neeraj Sood is a professor and vice dean for research at the Sol Price School for Public Policy and director of research at the Leonard D. Schaeffer Center for Health Policy and Economics, both at the University of Southern California.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Sood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000534:rehabilitation / Q000706:statistics & numerical data; D018588:Fee-for-Service Plans / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000534:rehabilitation; D006801:Humans; D008297:Male; D020398:Medicare Part C / Q000191:economics / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D020521:Stroke / Q000628:therapy; D019467:Subacute Care / Q000191:economics / Q000379:methods*; D014481:United States
keywords: Cost of Health Care; Managed Care - Medicare < Managed Care; Medicare