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- Title
Relationships Between Medicare Advantage Contract Characteristics and Quality-of-Care Ratings.
- Authors
Peng Xu; Burgess Jr., James F.; Cabral, Howard; Soria-Saucedo, Rene; Kazis, Lewis E.
- Abstract
Background: The Centers for Medicare & Medicaid Services (CMS) publishes star ratings on Medicare Advantage (MA) contracts to measure plan quality of care with implications for reimbursement and bonuses. Objective: To investigate whether MA contract characteristics are associated with quality of care through the Medicare plan star ratings. Design: Retrospective study of MA star ratings in 2010. Unadjusted and adjusted multivariable linear regression models assessed the relationship between 5-star rating summary scores and plan characteristics. Setting: CMS MA contracts nationally. Participants: 409 (71%) of a total of 575 MA contracts, covering 10.56 million Medicare beneficiaries (90% of the MA population) in the United States in 2010. Measurements: The MA quality ratings summary score (stars range from 1 to 5) is a quality measure based on 36 indicators related to processes of care, health outcomes, access to care, and beneficiary satisfaction. Results: Nonprofit, larger, and older MA contracts were more likely to receive higher star ratings. Star ratings ranged from 2 to 5. Nonprofit contracts received an average 0.55 (95% CI, 0.42 to 0.67) higher star ratings than for-profit contracts (P < 0.001) after controls were set for contract characteristics. Limitation: The study focused on persons aged 65 years or older covered by MA. Conclusion: In 2010, nonprofit MA contracts received significantly higher star ratings than for-profit contracts. When comparing health plans in the future, the CMS should give increasing attention to for-profit plans with lower quality ratings and consider developing programs to assist newer and smaller plans in improving their care for Medicare beneficiaries. Primary Funding Source: None.
- Subjects
MEDICAL quality control; MEDICARE beneficiaries; MEDICARE; CENTERS for Medicare &; Medicaid Services (U.S.); HEALTH planning; COMPARATIVE studies
- Publication
Annals of Internal Medicine, 2015, Vol 162, Issue 5, p353
- ISSN
0003-4819
- Publication type
Article
- DOI
10.7326/M14-0332