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- Title
Incorporating Medicare Advantage Admissions Into the CMS Hospital-Wide Readmission Measure.
- Authors
Kyanko, Kelly; Sahay, Kashika M.; Wang, Yongfei; Li, Shu-Xia; Schreiber, Michelle; Hager, Melissa; Myers, Raquel; Johnson, Wanda; Zhang, Jing; Krumholz, Harlan; Suter, Lisa G.; Triche, Elizabeth W.
- Abstract
Key Points: Question: What are the outcomes of incorporating Medicare Advantage (MA) beneficiaries into the Centers for Medicare & Medicaid Services Hospital-Wide Readmission (HWR) measure? Findings: In this cohort study using data from July 2018 to June 2019 for 11 029 470 Medicare admissions, mean hospital risk-adjusted readmission rates were similar for the combined fee-for-service (FFS) and MA cohort and FFS-only cohort (15.5% vs 15.3%). After adding MA admissions to the FFS-only measure, 1489 (33.1%) of all hospitals and 408 (45.3%) in the highest quintile of MA admissions had a change in performance quintile ranking. Meaning: These results suggest that adding MA beneficiaries to the HWR measure results in meaningful shifts in hospital performance. This cohort study investigates the outcomes of incorporating Medicare Advantage data into the Centers for Medicare & Medicaid Services (CMS) claims-based FFS Hospital-Wide All-Cause Unplanned Readmission measure and hospital performance quintile ranking. Importance: Medicare Advantage (MA) enrollment is rapidly expanding, yet Centers for Medicare & Medicaid Services (CMS) claims-based hospital outcome measures, including readmission rates, have historically included only fee-for-service (FFS) beneficiaries. Objective: To assess the outcomes of incorporating MA data into the CMS claims-based FFS Hospital-Wide All-Cause Unplanned Readmission (HWR) measure. Design, Setting, and Participants: This cohort study assessed differences in 30-day unadjusted readmission rates and demographic and risk adjustment variables for MA vs FFS admissions. Inpatient FFS and MA administrative claims data were extracted from the Integrated Data Repository for all admissions for Medicare beneficiaries from July 1, 2018, to June 30, 2019. Measure reliability and risk-standardized readmission rates were calculated for the FFS and MA cohort vs the FFS-only cohort, overall and within specialty subgroups (cardiorespiratory, cardiovascular, medicine, surgery, neurology), then changes in hospital performance quintiles were assessed after adding MA admissions. Main Outcome and Measure: Risk-standardized readmission rates. Results: The cohort included 11 029 470 admissions (4 077 633 [37.0%] MA; 6 044 060 [54.8%] female; mean [SD] age, 77.7 [8.2] years). Unadjusted readmission rates were slightly higher for MA vs FFS admissions (15.7% vs 15.4%), yet comorbidities were generally lower among MA beneficiaries. Test-retest reliability for the FFS and MA cohort was higher than for the FFS-only cohort (0.78 vs 0.73) and signal-to-noise reliability increased in each specialty subgroup. Mean hospital risk-standardized readmission rates were similar for the FFS and MA cohort and FFS-only cohorts (15.5% vs 15.3%); this trend was consistent across the 5 specialty subgroups. After adding MA admissions to the FFS-only HWR measure, 1489 hospitals (33.1%) had their performance quintile ranking changed. As their proportion of MA admissions increased, more hospitals experienced a change in their performance quintile ranking (147 hospitals [16.3%] in the lowest quintile of percentage MA admissions; 408 [45.3%] in the highest). The combined cohort added 63 hospitals eligible for public reporting and more than 4 million admissions to the measure. Conclusions and Relevance: In this cohort study, adding MA admissions to the HWR measure was associated with improved measure reliability and precision and enabled the inclusion of more hospitals and beneficiaries. After MA admissions were included, 1 in 3 hospitals had their performance quintile changed, with the greatest shifts among hospitals with a high percentage of MA admissions.
- Subjects
STATISTICAL correlation; PEARSON correlation (Statistics); CENTERS for Medicare &; Medicaid Services (U.S.); HEALTH insurance reimbursement; MEDICAL quality control; USER charges; PROSPECTIVE payment systems; MEDICARE; PATIENT readmissions; HOSPITAL care; FEE for service (Medical fees); LOGISTIC regression analysis; HEALTH insurance; DESCRIPTIVE statistics; LONGITUDINAL method; RESEARCH; DATA analysis software
- Publication
JAMA Network Open, 2024, Vol 7, Issue 6, pe2414431
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.14431