Potentially Inappropriate Medication Use Following Hospital Discharge Among Medicare Beneficiaries

Medicare beneficiaries 65 years and older are susceptible to receiving potentially inappropriate medications (PIMs), for which the risks outweigh the benefits. Unlike stand-alone Part D prescription drug plans serving traditional Medicare (TM) beneficiaries, Medicare Advantage (MA) plans have a financial incentive to improve transitional care following hospitalization and reduce PIM use in order to avoid costly adverse drug events. This study examined how changes in PIM use following hospitalization differed between TM and MA.

This observational study analyzed nationwide Medicare Part D Event files, TM fee-for-service claims, and MA encounter data from 2016 to 2019. It included 675,776 hospitalization episodes for Medicare beneficiaries 65 years and older with Part D prescription drug coverage.

We conducted a difference-in-differences analysis of PIM use before and after hospitalization between TM and MA. PIM use was measured as any Part D dispensing event for a high-risk medication during the 180 days before and after hospitalization.

The prevalence of PIM use in TM was 23.90% preadmission and 23.29% post discharge and in MA was 21.82% preadmission and 21.47% post discharge. After adjusting for patient factors, the decrease in PIM use following hospitalization was 0.25 percentage points (95% CI, 0.02-0.49) less in MA than in TM.

Although MA plans are likely to have stronger financial incentives than TM to reduce PIM use, we found that MA and TM beneficiaries experienced similar changes in PIM use following hospitalization.