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
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Background
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.
Objectives
To compare MA and FFS enrollees' quality of NH care.
Design
Cross-sectional.
Setting
US nursing homes.
Participants
2.17 million Medicare enrollees receiving care at an NH during 2011.
Measurements
CMS methodology was used to calculate the 18 Nursing Home Compare quality measures as applicable for each enrollee.
Results
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.
Conclusion
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.
This article was published outside of RAND. The full text of the article can be found at the link above.
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