Hospital Readmission Rates in Medicare Advantage Plans

Am J Manag Care. 2012 Feb;18(2):96-104.

Abstract

Objectives: To compute a benchmark for tracking readmission rates among patients enrolled in Medicare's private comprehensive Medicare Advantage (MA) plans and to develop preliminary comparisons with the fee-for-service (FFS) readmission rates.

Study design: Descriptive data presentation with analytic discussion.

Methods: We computed a benchmark for rehospitalization rates among MA patients using data from a commercial registry. To compare readmission rates between FFS and MA patients, we analyzed differences in demographics, geography, time period, entitlement status, and risk of readmission based on major diagnosis associated with the admission and the presence of complicating conditions.

Results: We found an unadjusted 30-day hospital readmission rate in the MA sample of 14.5% in 2006-2008. Results from contemporaneous comparisons between FFS and MA in the 2006-2008 period showed MA 30-day readmission rates were 22% lower than FFS readmission rates, before risk or other adjustments. After adjusting for risk of readmission (using distributions of major diagnosis codes and their respective likelihoods of readmission) and excluding patients under age 65 years (ie, those entitled to Medicare because of disability) from the comparison, we estimated that 30-day readmission rates for MA patients were approximately 13% to 20% lower than those for FFS patients in the 2006-2008 period.

Conclusions: We measured substantial differences in the risk-adjusted rates of hospital readmission among Medicare FFS and MA patients in our samples.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Benchmarking
  • Fee-for-Service Plans / economics
  • Fee-for-Service Plans / statistics & numerical data*
  • Female
  • Humans
  • Insurance Claim Review
  • Male
  • Medicare Part C / economics
  • Medicare Part C / statistics & numerical data*
  • Middle Aged
  • Patient Readmission / economics
  • Patient Readmission / statistics & numerical data*
  • United States