- Between 2011 and 2014, readmission rates were higher for patients in Medicare Advantage than for their peers in traditional Medicare plans, a study published in the Annals of Internal Medicine finds.
- Researchers analyzed 4.3 million readmissions for Medicare patients and found higher rates in MA for three conditions: acute myocardial infarction (AMI)(17.2% versus 16.9%), congestive heart failure (CHF) (21.7% versus 21.4%), and pneumonia (16.5% versus 16.0%).
- Hospital readmissions cost Medicare $26 billion annually, and hospitals, physicians and payers such as the Medicare program are trying to bring readmission rates down.
The study adds to a body of research analyzing the Medicare Hospital Readmission Reduction Program's effect on patient outcomes. Mandated in the Affordable Care Act, the program incentivizes hospitals to reduce risk-standardized 30-day readmissions for AMI, CHF, pneumonia, chronic obstructive pulmonary disease, hip and knee replacements and coronary artery bypass graft surgery.
Under the program, CMS assigns financial penalties to hospitals with higher-than-expected readmission rates.
Previous studies differed on whether the program puts vulnerable patients at risk. A 2018 study in JAMA found post-discharge mortality for heart failure patients rose following the announcement of the Hospital Readmission Reduction Program and after its implementation. Meanwhile, a 2017 study in JAMA Cardiology found the program reduced heart failure readmissions but mortality rates in patients went up. However, another JAMA study published in 2018 found no link between HRRP and increases in in-hospital or post-discharge mortality rates among Medicare beneficiaries.
The study authors aren't the first to analyze outcomes for MA patients. They note their findings are at odds with earlier studies that found lower or statistically similar readmission rates for MA. The authors suggest the difference in findings could be a result of incomplete data in the earlier studies.
For their study, the researchers identified readmissions by compiling information from multiple datasets. They found readmission rates were higher for Medicare Advantage patients than for traditional Medicare patients in all four years for each condition except for AMI in 2011. They also found the difference in readmission rates increased between 2011 and 2014, spanning the years in which HRRP was first implemented and during which financial penalties were introduced.
Given the rapidly growing number of patients enrolled in MA plans, the authors suggest analyzing readmission rates for patients enrolled in one of these plans is necessary to paint a complete picture of clinical outcomes for Medicare enrollees.