Hospital Stays Shown To Be Less Expensive, Shorter for Medicare Advantage Patients With Mental Health Issues

Hospital stays for mental health care were substantially less expensive and shorter for seniors with Medicare Advantage insurance coverage than for those with traditional Medicare in 2013, according to a new AHRQ study of more than 7.8 million hospitalizations in 22 states. The authors did not pinpoint a reason for the difference, but they suggested one factor might have been Medicare Advantage’s emphasis on providing outpatient treatment rather than more appropriate inpatient care. The study also found that Medicare Advantage hospital stays for surgery and injury were costlier and longer than traditional Medicare admissions. The costs and lengths of stay for medical admissions were comparable for the two Medicare programs, the study found. “Medicare Advantage and Traditional Medicare Hospitalization Intensity and Readmissions” was published March 8 in Medicare Care Research and Review. Access the abstract.

Medicare Advantage and Traditional Medicare Hospitalization

Intensity and Readmissions

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Rachel Mosher Henke , Zeynal Karaca, Teresa B. Gibson, Eli Cutler, Marguerite L. Barrett, Katharine Levit, Jayne Johann, Lauren Hersch Nicholas, Herbert S. Wong

First Published March 8, 2017

Abstract

Medicare Advantage plans have incentives and tools to optimize patient care. Therefore, Medicare Advantage hospitalizations may have lower cost and higher quality than similar traditional Medicare hospitalizations. We applied a coarsened matching approach to 2013 Healthcare Cost and Utilization Project hospital discharge data from 22 states to compare hospital cost, length of stay, and readmissions for Traditional Medicare and Medicare Advantage. We found that Medicare Advantage hospitalizations were substantially less expensive and shorter for mental health stays but costlier and longer for injury and surgical stays. We found little difference in the cost and length of medical stays and in readmission rates. One explanation is that Medicare Advantage plans use outpatient settings for many patients with behavioral health conditions and for injury and surgical patients with less complex health needs. Alternatively, the observed differences in behavioral health cost and length of stay may represent skimping on appropriate care.

References

	Baicker K., Chernew M. E., Robbins J. A. (2013). The spillover effects of Medicare managed care: Medicare Advantage and hospital utilization. Journal of Health Economics, 32, 1289-1300. Google Scholar CrossRef, Medline
	Baicker K., Robbins J. A. (2015). Medicare payments and system-level health-care use: The spillover effects of Medicare managed care. American Journal of Health Economics, 1, 399-431. Google Scholar CrossRef, Medline
	Baker L. C. (1997). The effect of HMOs on fee-for-service health care expenditures: Evidence from Medicare. Journal of Health Economics, 16, 453-481. Google Scholar CrossRef, Medline
	Baker L. C., Bundorf M. K., Devlin A. M., Kessler D. P. (2016). Medicare Advantage plans pay hospitals less than traditional Medicare Pays. Health Affairs (Millwood), 35, 1444-1451. Google Scholar CrossRef, Medline
	Bazzoli G. J., Shortell S. M., Dubbs N., Chan C., Kralovec P. (1999). A taxonomy of health networks and systems: Bringing order out of chaos. Health Services Research, 33, 1683-1717. Google Scholar Medline
	Blackwell M., Iacus S., King G., Porro G. (2009). CEM: Coarsened Exact Matching in Stata. Stata Journal, 9, 524-546. Google Scholar
	Buntin M. B., Zaslavsky A. M. (2004). Too much ado about two-part models and transformation? Comparing methods of modeling Medicare expenditures. Journal of Health Economics, 23, 525-542. Google Scholar CrossRef, Medline
	Centers for Medicare & Medicaid Services. (2013). Medicare-Medicaid Dual Enrollment from 2001 through 2011 (Data Analysis Brief). Retrieved from https://www.cms.gov/medicare-medicaid-coordination/medicare-and-medicaid-coordination/medicare-medicaid-coordination-office/downloads/dual_enrollment_2006-2011_final_document.pdf Google Scholar
	Chernew M., DeCicca P., Town R. (2008). Managed care and medical expenditures of Medicare beneficiaries. Journal of Health Economics, 27, 1451-1461. Google Scholar CrossRef, Medline
	Cutler D. M., McClellan M., Newhouse J. P. (2000). How does managed care do it? Rand Journal of Economics, 31, 526-548. Google Scholar CrossRef, Medline
	Friedman B., Jiang H. J., Steiner C. A., Bott J. (2012). Likelihood of hospital readmission after first discharge: Medicare Advantage vs. fee-for-service patients. INQUIRY: The Journal of Health Care Organization, Provision and Financing, 49, 202-213. Google Scholar Link
	Gold M., Casillas G. (2014). What do we know about health care access and quality in Medicare Advantage versus the traditional Medicare Program? Menlo Park, CA: Kaiser Family Foundation. Retrieved from http://files.kff.org/attachment/What-Do-We-Know-About-Health-Care-Access-and-Quality-in-Medicare-Advantage Google Scholar
	Guo S., Fraser M. W. (2010). Propensity score analysis: Statistical methods and applications. Thousand Oaks, CA: Sage. Google Scholar
	Healthcare Cost and Utilization Project. (2009). Cost-to-Charge Ratio Files. Retrieved from www.hcup-us.ahrq.gov/db/state/costtocharge.jsp Google Scholar
	Iacus S. M., King G., Porro G. (2011). Causal inference without balance checking: Coarsened exact matching. Political Analysis. Retrieved from http://gking.harvard.edu/files/political_analysis-2011-iacus-pan_mpr013.pdf Google Scholar
	Kaiser Family Foundation. (2015a). Financial and administrative alignment demonstrations for dual eligible beneficiaries compared: States with memoranda of understanding approved by CMS (Issue Brief). Retrieved from http://files.kff.org/attachment/issue-brief-financial-and-administrative-alignment-demonstrations-for-dual-eligible-beneficiaries-compared Google Scholar
	Kaiser Family Foundation. (2015b). Medicare Advantage enrollees as a percent of total Medicare population. Retrieved from http://kff.org/medicare/state-indicator/enrollees-as-a-of-total-medicare-population/ Google Scholar
	Kaiser Family Foundation. (2016a). Medicare Advantage. Retrieved from http://kff.org/medicare/fact-sheet/medicare-advantage/ Google Scholar
	Kaiser Family Foundation. (2016b). Medicare Advantage: Total enrollment. Retrieved from http://kff.org/medicare/state-indicator/ma-total-enrollment/ Google Scholar
	Kaiser Family Foundation. (2016c). Similar but not the same: How Medicare per capita spending compares for younger and older beneficiaries. Retrieved from http://files.kff.org/attachment/data-note-Similar-But-Not-the-Same-How-Medicare-Per-Capita-Spending-Compares-For-Younger-and-Older-Beneficiaries Google Scholar
	Lemieux J., Sennett C., Wang R., Mulligan T., Bumbaugh J. (2012). Hospital readmission rates in Medicare Advantage plans. American Journal of Managed Care, 18, 96-104. Google Scholar Medline
	McGuire T. G., Pauly M. V. (1991). Physician response to fee changes with multiple payers. Journal of Health Economics, 10, 385-410. Google Scholar CrossRef, Medline
	Medicare Payment Advisory Commission. (2015a). Report to the Congress: Medicare and the health care delivery system. Retrieved from http://www.medpac.gov/docs/default-source/reports/june-2015-report-to-the-congress-medicare-and-the-health-care-delivery-system.pdf?sfvrsn=0 Google Scholar
	Medicare Payment Advisory Commission. (2015b). Report to the Congress: Medicare Payment Policy. Retrieved from http://www.medpac.gov/documents/reports/mar2015_entirereport_revised.pdf?sfvrsn=0 Google Scholar
	Nicholas L. H. (2013). Better quality of care or healthier patients? Hospital utilization by Medicare Advantage and fee-for-service enrollees. Forum for Health Economics & Policy, 16(1), 137-161. Google Scholar CrossRef, Medline
	Raetzman S. O., Hines A. L., Barrett M. L., Karaca Z. (2015). Hospital stays in Medicare Advantage plans versus the traditional Medicare fee-for-service program, 2013 (HCUP Statistical Brief 198). Rockville, MD: Agency for Healthcare Research and Quality. Google Scholar
	Rosenbaum P. R., Rubin D. B. (1983). The central role of the propensity score in observational studies for causal effects. Biometrika, 70, 41-55. Google Scholar CrossRef
	Rosko M. D., Mutter R. L. (2008). Stochastic frontier analysis of hospital inefficiency: A review of empirical issues and an assessment of robustness. Medical Care Research and Review, 65, 131-166. Google Scholar Link
	Stevenson D. G., Ayanian J. Z., Zaslavsky A. M., Newhouse J. P., Landon B. E. (2013). Service use at the end of life in Medicare Advantage versus Traditional Medicare. Medical Care, 51, 931-937. Google Scholar CrossRef, Medline
	Valdmanis V. G., Rosko M. D., Mutter R. L. (2008). Hospital quality, efficiency, and input slack differentials. Health Services Research, 43(5, Pt. 2), 1830-1848. Google Scholar CrossRef, Medline
	Zuckerman S., Hadley J., Iezzoni L. (1994). Measuring hospital efficiency with frontier cost functions. Journal of Health Economics, 13, 335-340. Google Scholar CrossRef