Does Medicare Advantage Enrollment Affect Home Healthcare Use?

OBJECTIVES: To compare home health utilization andclinical outcomes between Medicare beneficiaries in the feefor-service (FFS) and Medicare Advantage (MA) programs,and to compare regional variation.STUDY DESIGN: We used the 2010 and 2011 Outcome andAssessment Information Set to identify all home healthepisodes begun in 2010 and to measure 7 clinical home healthoutcomes that are defined by CMS for public reporting.METHODS: We modeled the probability of home healthuse, the duration of home health episodes, and eachclinical outcome measure as a function of MA versus FFSenrollment and model-specific risk adjustors. EmpiricalBayes predictions from generalized linear mixed modelswere aggregated by hospital referral region (HRR) to createstandardized regional measures of home health utilizationand mean episode duration.RESULTS: We identified 30,837,130 FFS and 10,594,658 MAbeneficiaries (excluding those dually eligible for Medicaid).After adjusting for demographic and clinical patientcharacteristics, the odds of receiving home health amongFFS enrollees were 1.83 times those of MA (95% CI, 1.82-1.84). Adjusted home health duration was 34% longer forFFS (95% CI, 32%-34%). Outcomes differences were smallin magnitude and inconsistent across measures. Regionalvariations in use and duration were substantial for both FFSand MA enrollees. Within HRRs, correlations between FFSand MA utilization rates and between FFS and MA episodedurations were 0.51 and 0.94, respectively.CONCLUSIONS: MA beneficiaries use less home healththan their FFS counterparts, but regional factors affectutilization, independent of insurance status.