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Incorporating Medicare Advantage Admissions Into the CMS Hospital-Wide Readmission Measure.

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Area of Science:

  • Health Services Research
  • Healthcare Quality Improvement
  • Public Health Policy

Background:

  • Medicare Advantage (MA) enrollment is increasing, yet traditional Centers for Medicare & Medicaid Services (CMS) hospital outcome measures exclude MA beneficiaries.
  • This exclusion limits the comprehensive assessment of hospital performance and quality for a growing segment of the Medicare population.

Purpose of the Study:

  • To evaluate the impact of incorporating Medicare Advantage (MA) claims data into the CMS Hospital-Wide All-Cause Unplanned Readmission (HWR) measure.
  • To assess changes in measure reliability, risk-standardized readmission rates, and hospital performance rankings after including MA admissions.

Main Methods:

  • A cohort study analyzing inpatient administrative claims data for Medicare beneficiaries from July 2018 to June 2019.
  • Compared readmission rates and risk adjustment variables between MA and Fee-for-Service (FFS) admissions.
  • Calculated measure reliability and risk-standardized readmission rates for FFS-only and combined FFS/MA cohorts.
  • Assessed changes in hospital performance quintile rankings after adding MA admissions.

Main Results:

  • The study included over 11 million admissions, with 37% from MA beneficiaries.
  • Test-retest reliability (0.78 vs 0.73) and signal-to-noise reliability improved with MA data inclusion.
  • Mean hospital risk-standardized readmission rates remained similar (15.5% vs 15.3%) between FFS-only and combined cohorts.
  • One in three (33.1%) hospitals experienced a change in their performance quintile ranking, with greater shifts in hospitals with higher MA enrollment.

Conclusions:

  • Incorporating MA admissions into the HWR measure enhances reliability and precision.
  • The inclusion of MA data allows for a more comprehensive assessment of hospital performance, covering more beneficiaries.
  • Hospital performance rankings are significantly affected by MA data, especially for facilities serving a larger MA population.