Orestis A. Panagiotou, MD, PhD; Amit Kumar, PT, MPH, PhD; Roee Gutman, PhD; Laura M. Keohane, PhD; Maricruz Rivera-Hernandez, PhD; Momotazur Rahman, PhD; Pedro L. Gozalo, PhD; Vincent Mor, PhD; Amal N. Trivedi, MD, MPH
Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government.
Acknowledgment: The authors thank Kirsten R. Voorhies, BS, and Derek Lake, MSc (Brown University), for their help with figures.
Financial Support: By grants R01AG047180 and P01AG027296 from the National Institute on Aging of the National Institutes of Health.
Disclosures: Dr. Keohane reports grants from the National Institute on Aging during the conduct of the study. Dr. Rivera-Hernandez reports grants from the National Institute on Aging and the National Institute of General Medical Sciences during the conduct of the study. Dr. Mor reports personal fees from HCR ManorCare and naviHealth outside the submitted work. Dr. Trivedi reports grants from the National Institute on Aging during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1795.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Panagiotou (e-mail, email@example.com).
Corresponding Author: Orestis A. Panagiotou, MD, PhD, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Panagiotou, Gutman, Rivera-Hernandez, Rahman, Gozalo, Mor, and Trivedi: Brown University School of Public Health, 121 South Main Street, Providence, RI 02903.
Dr. Kumar: College of Health & Human Services, Northern Arizona University, 208 East Pine Knoll Drive, Building 66, Flagstaff, AZ 86011.
Dr. Keohane: Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 1200, Nashville, TN 37203.
Author Contributions: Conception and design: O.A. Panagiotou, R. Gutman, M. Rahman, V. Mor, A.N. Trivedi.
Analysis and interpretation of the data: O.A. Panagiotou, A. Kumar, R. Gutman, L.M. Keohane, M. Rivera-Hernandez, M. Rahman, P.L. Gozalo, V. Mor, A.N. Trivedi.
Drafting of the article: O.A. Panagiotou, R. Gutman, M. Rahman, V. Mor, A.N. Trivedi.
Critical revision of the article for important intellectual content: A. Kumar, R. Gutman, L.M. Keohane, M. Rivera-Hernandez, M. Rahman, P.L. Gozalo, V. Mor, A.N. Trivedi.
Final approval of the article: O.A. Panagiotou, A. Kumar, R. Gutman, L.M. Keohane, M. Rivera-Hernandez, M. Rahman, V. Mor, A.N. Trivedi.
Provision of study materials or patients: O.A. Panagiotou, A. Kumar, L.M. Keohane, M. Rivera-Hernandez, V. Mor.
Statistical expertise: O.A. Panagiotou, R. Gutman, M. Rahman, V. Mor.
Obtaining of funding: M. Rahman, V. Mor, A.N. Trivedi.
Administrative, technical, or logistic support: M. Rahman, V. Mor, A.N. Trivedi.
Collection and assembly of data: O.A. Panagiotou, A. Kumar, M. Rahman, V. Mor.
Medicare's Hospital Readmissions Reduction Program reports risk-standardized readmission rates for traditional Medicare but not Medicare Advantage beneficiaries.
To compare readmission rates between Medicare Advantage and traditional Medicare.
Retrospective cohort study linking the Medicare Provider Analysis and Review (MedPAR) file with the Healthcare Effectiveness Data and Information Set (HEDIS).
4748 U.S. acute care hospitals.
Patients aged 65 years or older hospitalized for acute myocardial infarction (AMI) (n = 841 613), congestive heart failure (CHF) (n = 1 458 652), or pneumonia (n = 2 020 365) between 2011 and 2014.
Among admissions for AMI, CHF, and pneumonia identified in MedPAR, 29.2%, 38.0%, and 37.2%, respectively, did not have a corresponding record in HEDIS. Of these, 18.9% for AMI, 23.7% for CHF, and 18.3% for pneumonia resulted in a readmission that was identified in MedPAR. However, among index admissions appearing in HEDIS, 14.4% for AMI, 18.4% for CHF, and 13.9% for pneumonia resulted in a readmission. Patients in Medicare Advantage had lower unadjusted readmission rates than those in traditional Medicare for all 3 conditions (16.6% vs. 17.1% for AMI, 21.4% vs. 21.7% for CHF, and 16.3% vs. 16.4% for pneumonia). However, after standardization, patients in Medicare Advantage had higher readmission rates than patients in traditional Medicare for AMI (17.2% vs. 16.9%; difference, 0.3 percentage point [95% CI, 0.1 to 0.5 percentage point]), CHF (21.7% vs. 21.4%; difference, 0.3 percentage point [CI, 0.2 to 0.5 percentage point]), and pneumonia (16.5% vs. 16.0%; difference, 0.5 percentage point [95% CI, 0.4 to 0.6 percentage point]). Rate differences increased between 2011 and 2014.
Potential unobserved differences between populations.
The HEDIS data underreported hospital admissions for 3 common medical conditions, and readmission rates were higher among patients with underreported admissions. Medicare Advantage beneficiaries had higher risk-adjusted 30-day readmission rates than traditional Medicare beneficiaries.
National Institute on Aging.
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. [Epub ahead of print 25 June 2019]. doi: https://doi.org/10.7326/M18-1795
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Published: Ann Intern Med. 2019;171(2):99-106.
Published at www.annals.org on 25 June 2019
Healthcare Delivery and Policy, Hospital Medicine.
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