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Member Research and Reports

Member Research and Reports

Brown: Medicare Advantage Enrollees More Likely To Be Admitted to Average, Than Low or High Quality Hospitals

Researchers at the Brown University School of Public Health have just published a study comparing the quality of hospitals Medicare Advantage enrollees are admitted to compared to those in traditional Medicare are admitted to. Medicare Advantage is the privately run segment of the Medicare program where private insurance companies are paid annually to provide their enrollees withhealthcare services. The study was led by Mr. David Meyers, a doctoral candidate in the Department of Health Services, Policy and Practice at the school and was published in JAMA Network Open.

The authors used data from Medicare Provider Analysis and Review from 2012-2016. Quality of care was measured by using a star rating that was awarded to facilities by CMS as well as readmission rates – with low readmissions being potentially indicative of better quality than those hospitals with higher readmissions. They examined more than 12 million hospitalizations amongst 7.1 million enrollees. They found that for those enrolled in Medicare Advantage plans, for non-emergent care, they were 1.9 percentage points less likely to be admitted to a facility with a low readmission rate than the traditional Medicare group, 5.1 percentage points more likely to be admitted to a facility with an average readmission rate and 3.2 percentage points less likely to be admitted to facility with a high readmission rate.

Overall the results show that those in Medicare Advantage plans are more likely to be admitted to average quality hospitals than low or high quality hospitals. The authors suggest that plans may be steering enrollees to certain hospitals and recommend that enrollees and policymakers should pay attention to the quality of the hospitals in MA plans’ networks.

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