Health Care Costs and Financing

Medicare Advantage enrollees are admitted to hospitals with higher mortality rates than Medicare fee-for-service enrollees

The question of whether persons enrolled in Medicare Advantage (MA) plans use different hospitals or receive better or worse care has been difficult to test. Since these enrollees do not submit claims for reimbursement, Medicare does not receive detailed hospital discharge summaries. However, by using data from 1,500 hospitals submitted to 13 statewide databases for 2006, researchers have found that MA enrollees are more likely than Medicare fee-for-service (FFS) enrollees to receive care at hospitals with mortality rates 1.5 percent higher than the 4 percent overall mean. At the same time, MA enrollees receive care at hospitals with fewer patient safety problems (patient safety event scores 1 percent lower than the average of 3.5 percent). These discrepant results are possibly due to greater discretion by MA plans both in approving patients for elective surgery and in selecting hospitals for surgical patients, according to Bernard Friedman, Ph.D., and H. Joanna Jiang, Ph.D., of the Agency for Healthcare Research and Quality (AHRQ).

The remarkable difference between the safety results and mortality results may in part be explained by the fact that safety measures generally exclude emergency admissions, while the mortality categories include many emergency patients. When a patient is referred for an elective procedure, the health plan can have more discretionary impact on the use of surgery and the hospital selected for the procedure. It appears that MA plans are exercising that discretion. This could happen indirectly by the health plan's selection of physicians available to enrollees, note the researchers.

Their study used nine Patient Safety Indicators developed by AHRQ and reviewed by the National Quality Forum. The risk-adjusted mortality measure used only eight categories of surgical cases. The authors believe that their study demonstrates the types of comparative information that could help Medicare enrollees become better informed about outcome differences between hospitals.

See "Do Medicare Advantage enrollees tend to be admitted to hospitals with better or worse outcomes compared with fee-for-service enrollees?" by Drs. Friedman and Jiang in the February 2010 International Journal of Health Care Finance and Economics 10(2), pp. 171-185. Reprints (Publication No. 10-R042) are available from the AHRQ Publications Clearinghouse.

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