Cardiovascular hospitalizations for Medicare advantage beneficiaries in the United States, 2009 to 2019

Andrew S Oseran; Huaying Dong; Rishi K Wadhera

doi:10.1016/j.ahj.2023.07.002

Cardiovascular hospitalizations for Medicare advantage beneficiaries in the United States, 2009 to 2019

Am Heart J. 2023 Nov:265:77-82. doi: 10.1016/j.ahj.2023.07.002. Epub 2023 Jul 13.

Authors

Andrew S Oseran¹, Huaying Dong², Rishi K Wadhera³

Affiliations

¹ Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA; Division of Cardiology, Massachusetts General Hospital, Boston, MA.
² Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA.
³ Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: rwadhera@bidmc.harvard.edu.

PMID: 37451356
DOI: 10.1016/j.ahj.2023.07.002

Abstract

Background: Federal programs measuring hospital quality of care for acute cardiovascular conditions are based solely on Medicare fee-for-service (FFS) beneficiaries, and exclude Medicare Advantage (MA) beneficiaries. In this study we characterize the proportion of Medicare beneficiaries enrolled in MA at the time of acute myocardial infarction (AMI), heart failure (HF), and ischemic stroke hospitalization.

Methods: Retrospective cross-sectional study of short-term acute care hospitals using Medicare claims in 2009 and 2019.

Results: There were 2,653 hospitals in 2009 and 2,732 hospitals in 2019. Across hospitals, the proportion of Medicare beneficiaries hospitalized for AMI who were enrolled in MA increased between 2009 (hospital-level median 14.4% [IQR 5.1%-26.0%]) and 2019 (33.3% [IQR 20.6%-45.2%]), with substantial variation across hospitals. Similar patterns were observed for HF (13.0% [IQR 5.3%-24.3%] to 31.0% [IQR 20.2%-42.3%]) and ischemic stroke (14.6% [IQR 5.3%-26.7%] to 33.3% [IQR 20.9%-46.0%]). Within each hospital referral region, hospital size (large 36.3% vs small 24.5%; adjusted difference 6.7%, 95% CI, 4.5%-8.8%), teaching status (teaching 34.5% vs nonteaching 28.2%; 2.8%, 1.4%-4.1%), and ownership status (private nonprofit 32.3% vs public 24.5%; 5.2%, 3.5%-6.9%) were each associated with a higher hospital MA proportion.

Conclusions: The proportion of Medicare beneficiaries hospitalized for AMI, HF, and ischemic stroke enrolled in MA doubled between 2009 and 2019, with substantial variation across hospitals. These findings have implications for federal efforts to measure and improve quality, which currently focus only on FFS beneficiaries.