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

Shriram Parashuram, Seung Kim, Bryan E Dowd

Research output: Contribution to journalArticle

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

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Medicare Part C
Fee-for-Service Plans
Medicare
Ambulatory Care
Hospital Emergency Service
Health Status
Databases
Health

Keywords

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

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't

Cite this

Inappropriate Utilization in Fee-for-Service Medicare and Medicare Advantage Plans. / Parashuram, Shriram; Kim, Seung; Dowd, Bryan E.

In: American Journal of Medical Quality, Vol. 33, No. 1, 01.01.2018, p. 58-64.

Research output: Contribution to journalArticle

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