Untangling Differences in Quality of Care in Medicare Advantage Versus Traditional Medicare Programs
Authors: Peter Huckfeldt, Neeraj Sood
Journal: Annals of Internal Medicine (2019)

Editorials16 July 2019Untangling Differences in Quality of Care in Medicare Advantage Versus Traditional Medicare ProgramsPeter Huckfeldt, PhD and Neeraj Sood, PhDPeter Huckfeldt, PhDUniversity of Minnesota School of Public Health, Minneapolis, Minnesota (P.H.)Search for more papers by this author and Neeraj Sood, PhDUniversity of Southern California, Sol Price School of Public Policy and Schaeffer Center, Los Angeles, California (N.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-1599 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail A growing share of Medicare beneficiaries are enrolled in Medicare Advantage (MA) rather than traditional fee-for-service Medicare (TM), increasing from 13% in 2004 to 34% in 2018 (1). The Centers for Medicare & Medicaid Services (CMS) recently implemented policies that may expand the MA model (2), and the Congressional Budget Office projects that MA will cover nearly 47% of Medicare beneficiaries by 2029 (3). Given the growing popularity of MA, it is important to fully understand how it affects patient care and outcomes.In theory, MA plans should have lower costs. Under MA, CMS pays private health plans a monthly ...References1. Neuman P, Jacobson GA. Medicare Advantage checkup. N Engl J Med. 2018;379:2163-72. [PMID: 30428276] doi:10.1056/NEJMhpr1804089 CrossrefMedlineGoogle Scholar2. Centers for Medicare & Medicaid Services. CMS finalizes Medicare Advantage and Part D payment and policy updates to maximize competition and coverage [news release]. 1 April 2019. Accessed at www.cms.gov/newsroom/press-releases/cms-finalizes-medicare-advantage-and-part-d-payment-and-policy-updates-maximize-competition-and on 31 May 2019. Google Scholar3. Congressional Budget Office. Medicare—CBO's May 2019 baseline. Accessed at www.cbo.gov/system/files?file=2019-05/51302-2019-05-medicare_0.pdf on 31 May 2019. Google Scholar4. Panagiotou OA, Kumar A, Gutman R, et al. Hospital readmission rates in Medicare Advantage and traditional Medicare. A retrospective population-based analysis. Ann Intern Med. 2019;171:99-106. doi:10.7326/M18-1795 LinkGoogle Scholar5. Kumar A, Rahman M, Trivedi AN, et al. Comparing post-acute rehabilitation use, length of stay, and outcomes experienced by Medicare fee-for-service and Medicare Advantage beneficiaries with hip fracture in the United States: a secondary analysis of administrative data. PLoS Med. 2018;15:e1002592. [PMID: 29944655] doi:10.1371/journal.pmed.1002592 CrossrefMedlineGoogle Scholar6. Huckfeldt PJ, Escarce JJ, Rabideau B, et al. Less intense postacute care, better outcomes for enrollees in Medicare Advantage than those in fee-for-service. Health Aff (Millwood). 2017;36:91-100. [PMID: 28069851] doi:10.1377/hlthaff.2016.1027 CrossrefMedlineGoogle Scholar7. Geruso M, Layton T. Upcoding: evidence from Medicare on squishy risk adjustment. Cambridge, MA: National Bureau of Economic Research; 2018. NBER Working Paper 21222. Google Scholar8. Ibrahim AM, Dimick JB, Sinha SS, et al. Association of coded severity with readmission reduction after the Hospital Readmissions Reduction Program. JAMA Intern Med. 2018;178:290-2. [PMID: 29131896] doi:10.1001/jamainternmed.2017.6148 CrossrefMedlineGoogle Scholar9. Duggan M, Gruber J, Vabson B. The consequences of health care privatization: evidence from Medicare Advantage exits. Am Econ J Econ Policy. 2018;10:153-86. CrossrefGoogle Scholar10. Baicker K, Robbins JA. Medicare payments and system-level health-care use: the spillover effects of Medicare managed care. Am J Health Econ. 2015;1:399-431. [PMID: 27042687] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Minnesota School of Public Health, Minneapolis, Minnesota (P.H.)University of Southern California, Sol Price School of Public Policy and Schaeffer Center, Los Angeles, California (N.S.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1599.Corresponding Author: Peter Huckfeldt, PhD, University of Minnesota School of Public Health, 420 Delaware Street Southeast, MMC 729, Minneapolis, MN 55455; e-mail, [email protected]edu.Current Author Addresses: Dr. Huckfeldt: University of Minnesota School of Public Health, 420 Delaware Street Southeast, MMC 729, Minneapolis, MN 55455.Dr. Sood: University of Southern California, University Park Campus, VPD 210, Los Angeles, CA 90089.This article was published at Annals.org on 25 June 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHospital Readmission Rates in Medicare Advantage and Traditional Medicare Orestis A. Panagiotou , Amit Kumar , Roee Gutman , Laura M. Keohane , Maricruz Rivera-Hernandez , Momotazur Rahman , Pedro L. Gozalo , Vincent Mor , and Amal N. Trivedi Metrics Cited byAssociation of Medicare Advantage vs Traditional Medicare With 30-Day Mortality Among Patients With Acute Myocardial Infarction 16 July 2019Volume 171, Issue 2Page: 133-134KeywordsDiagnosis related groupsHealth careHealth care qualityHeart failureInformation storage and retrievalMedicareMotivationPatientsPneumoniaPrevention, policy, and public health ePublished: 25 June 2019 Issue Published: 16 July 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...