Less intense postacute care, better outcomes for enrollees in medicare advantage than those in fee-for-service

Peter J. Huckfeldt, José J. Escarce, Brendan Rabideau, Pinar Karaca-Mandic, Neeraj Sood

Research output: Contribution to journalArticlepeer-review

55 Scopus citations

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 highvolume 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.

Original languageEnglish (US)
Pages (from-to)91-100
Number of pages10
JournalHealth Affairs
Volume36
Issue number1
DOIs
StatePublished - 2017

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