Surgical Outcomes and Postacute Care Use Among Rural Medicare Advantage Beneficiaries

Area of Science:

• Health Services Research
• Surgical Outcomes
• Medicare Policy

Background:

• Rapid growth of Medicare Advantage (MA) enrollment in rural areas necessitates understanding its impact on surgical care delivery and outcomes.
• Differences in care coordination, network structures, and reimbursement within MA plans may influence surgical access, quality, and post-acute care for rural patients.

Purpose of the Study:

• To investigate the influence of Medicare Advantage (MA) enrollment on surgical care delivery and patient outcomes among rural beneficiaries.
• To compare mortality, complication rates, readmissions, and post-acute care utilization for rural surgical patients enrolled in MA versus traditional fee-for-service (FFS) Medicare.

Main Methods:

• Retrospective cohort study utilizing Medicare claims data from 2016-2020.
• Identified 176,864 rural beneficiaries undergoing three access-sensitive operations: abdominal aortic aneurysm repair, colectomy for cancer, or incisional hernia repair.
• Risk-adjusted outcomes were assessed using multivariable logistic regressions, comparing MA enrollees to FFS beneficiaries.

Main Results:

• No statistically significant differences in risk-adjusted 30-day mortality (4.9% vs. 5.0%) or complication rates (24.6% vs. 24.4%) between MA and FFS beneficiaries.
• MA patients exhibited significantly fewer risk-adjusted readmissions (12.5% vs. 14.6%).
• MA patients were more likely to be discharged home (OR=1.27) and less likely to be discharged to a skilled nursing facility (OR=0.82).

Conclusions:

• Rural surgical patients enrolled in Medicare Advantage plans experienced comparable mortality and complication rates to those in traditional fee-for-service Medicare.
• Medicare Advantage enrollment was associated with reduced readmissions and decreased utilization of post-acute care resources among rural surgical patients.
• Findings suggest MA plans may influence post-acute care pathways for rural surgical populations without compromising immediate surgical outcomes.