Differences in Nursing Home Quality Between Medicare Advantage and Traditional Medicare Patients

Published in: Journal of the American Medical Directors Association, v. 17, no. 10, 1 Oct. 2016, p. 960.e9-960.e14

Posted on RAND.org on October 18, 2016

by Emiley Chang, Teague Ruder, Claude Messan Setodji, Debra Saliba, Mark Alan Hanson, David Zingmond, Neil S. Wenger, David A. Ganz

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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.




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.

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