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Surgical Outcomes and Medicare Advantage Payer-Hospital Integration
Geronimo Bejarano1, Alexander P Philips1, David J Meyers1
1Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.
JAMA Surgery
|August 20, 2025
Summary
Hospitals offering their own Medicare Advantage (MA) plans and performing surgery within them show better patient outcomes. This integration of payer and hospital services may improve surgical care quality.
Area of Science:
- Health Services Research
- Health Policy
- Surgical Outcomes
Background:
- Hospitals are increasingly offering integrated insurance plans, including Medicare Advantage (MA).
- The impact of payer-hospital integration on surgical care quality remains unclear.
Purpose of the Study:
- To evaluate postsurgical outcomes in patients with varying exposure to Medicare Advantage payer-hospital integration.
- To determine if integrated MA plans influence surgical care quality.
Main Methods:
- Serial cross-sectional study of inpatient MA admissions for major surgeries (2015-2022).
- Categorization of MA coverage: nonintegrated, partially integrated, and fully integrated.
- Multivariable generalized linear models used to assess outcomes, adjusting for patient and hospital characteristics.
Main Results:
- Fully integrated admissions showed significantly lower rates of complications, serious complications, and ICU use compared to nonintegrated admissions.
- Fully integrated admissions also had a shorter length of stay than nonintegrated admissions.
- Compared to partially integrated admissions, fully integrated admissions had lower rates of serious complications and ICU use, and shorter length of stay.
Conclusions:
- Enrolling in a hospital-owned MA plan and receiving surgery at the affiliated hospital is associated with improved postsurgical outcomes.
- Aligned incentives and coordinated care in integrated payer-hospital systems may enhance surgical care quality.
- Findings have significant implications for healthcare policy as MA enrollment grows.
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