Post-Acute Care Use Associated with Medicare Shared Savings Program and Disparities

Area of Science:

• Health Services Research
• Health Economics
• Public Health Policy

Background:

• The Medicare Shared Savings Program (MSSP) aims to improve care quality and reduce costs.
• Impacts of MSSP on post-acute care (PAC) utilization, particularly by demographic and payer groups, remain understudied.
• Understanding these disparities is crucial for equitable healthcare delivery.

Purpose of the Study:

• To assess the effect of hospital participation in the MSSP on institutional PAC use.
• To examine variations in PAC use by race/ethnicity and payer status within the MSSP framework.
• To analyze these impacts across three key Medicare patient cohorts: ischemic stroke, hip fracture, and total joint arthroplasty.

Main Methods:

• Retrospective analysis of Medicare Provider Analysis and Review (MedPAR) files from 2010-2016.
• Utilized patient-level linear probability models with a difference-in-differences approach.
• Compared institutional PAC use changes between MSSP-participating and nonparticipating hospitals over time.

Main Results:

• MSSP participation was linked to a 1.5 percentage point increase in institutional PAC use for ischemic stroke patients.
• Racial minority patients undergoing elective TJA in MSSP hospitals had 3.8 percentage points higher PAC use than white patients.
• Dual-eligible ischemic stroke patients in MSSP hospitals showed 2.0 percentage points greater PAC use compared to Medicare-only patients.

Conclusions:

• Hospital participation in MSSP is associated with a modest rise in institutional PAC use for ischemic stroke patients.
• MSSP hospitals demonstrated higher rates of discharging racial minority elective TJA patients and dual-eligible ischemic stroke patients to institutional PAC.
• Findings highlight potential disparities in PAC utilization influenced by MSSP participation and patient characteristics.