Differences in Nursing Home Quality Between Medicare Advantage and Traditional Medicare Patients

Journal of the American Medical Directors Association

Volumn 17, Issue 10, 2016, Pages 960.e9-960.e14

  Chang, Emiley ^a   Ruder, Teague ^b   Setodji, Claude ^b   Saliba, Debra ^a,b,c,d   Hanson, Mark ^b   Zingmond, David S ^a   Wenger, Neil S ^a,b   Ganz, David A ^a,b,c,d  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b RAND CORPORATION   (United States)

^c VETERANS AFFAIRS MEDICAL CENTER   (United States)

^d VA GREATER LOS ANGELES HEALTHCARE SYSTEM   (United States)

Author keywords

Medicare Advantage; nursing homes; quality measures

Indexed keywords

NEUROLEPTIC AGENT;

ADULT; ADVERSE OUTCOME; AGED; ANALGESIA; ARTICLE; BLADDER CATHETERIZATION; CHRONIC PATIENT; DECUBITUS; FECES INCONTINENCE; FEMALE; HEALTH CARE QUALITY; HUMAN; MAJOR CLINICAL STUDY; MALE; MEDICARE; NURSING HOME; NURSING HOME PATIENT; PSYCHOPHARMACOTHERAPY; URINE INCONTINENCE; COMPARATIVE STUDY; CROSS-SECTIONAL STUDY; STANDARDS; UNITED STATES; VERY ELDERLY;

AGED; AGED, 80 AND OVER; CROSS-SECTIONAL STUDIES; FEMALE; HUMANS; MALE; MEDICARE; MEDICARE PART C; NURSING HOMES; UNITED STATES;

EID: 84995704303     PISSN: 15258610     EISSN: 15389375     Source Type: Journal    
DOI: 10.1016/j.jamda.2016.07.017     Document Type: Article

References (51)

1. 1 The Henry J. Kaiser Family Foundation. Medicare Advantage Fact Sheet. Available at: http://kff.org/medicare/fact-sheet/medicare-advantage-fact-sheet/. Published online June 29, 2015. Accessed January 14, 2016.
2. 2 Safran, D.G., Wilson, I.B., Rogers, W.H., et al. Primary care quality in the Medicare Program: Comparing the performance of Medicare health maintenance organizations and traditional fee-for-service medicare. Arch Intern Med 162 (2002), 757–765.
3. 3 Landon, B.E., Zaslavsky, A.M., Bernard, S.L., et al. Comparison of performance of traditional Medicare vs Medicare managed care. JAMA 291 (2004), 1744–1752.
4. 4 Keenan, P.S., Elliott, M.N., Cleary, P.D., et al. Quality assessments by sick and healthy beneficiaries in traditional Medicare and Medicare managed care. Med Care 47 (2009), 882–888.
5. 5 Luft, H.S., Variations in patterns of care and outcomes after acute myocardial infarction for Medicare beneficiaries in fee-for-service and HMO settings. Health Serv Res 38 (2003), 1065–1079.
6. 6 Soumerai, S.B., McLaughlin, T.J., Gurwitz, J.H., et al. Timeliness and quality of care for elderly patients with acute myocardial infarction under health maintenance organization vs fee-for-service insurance. Arch Intern Med 159 (1999), 2013–2020.
7. 7 Kramer, A.M., Kowalsky, J.C., Lin, M., et al. Outcome and utilization differences for older persons with stroke in HMO and fee-for-service systems. J Am Geriatr Soc 48 (2000), 726–734.
8. 8 Smith, M.A., Frytak, J.R., Liou, J.I., Finch, M.D., Rehospitalization and survival for stroke patients in managed care and traditional Medicare plans. Med Care 43 (2005), 902–910.
9. 9 Ayanian, J.Z., Landon, B.E., Zaslavsky, A.M., Newhouse, J.P., Racial and ethnic differences in use of mammography between Medicare Advantage and traditional Medicare. J Natl Cancer Inst 105 (2013), 1891–1896.
10. 10 Lee-Feldstein, A., Feldstein, P.J., Buchmueller, T., Katterhagen, G., Breast cancer outcomes among older women: HMO, fee-for-service, and delivery system comparisons. J Gen Intern Med 16 (2001), 189–199.
11. 11 Martino, S.C., Elliott, M.N., Haviland, A.M., et al. Comparing the Health Care Experiences of Medicare Beneficiaries with and without Depressive Symptoms in Medicare Managed Care versus Fee-for-Service. Health Serv Res 51 (2016), 1002–1020.
12. 12 Zeng, F., O'Leary, J.F., Sloss, E.M., et al. The effect of Medicare health maintenance organizations on hospitalization rates for ambulatory care-sensitive conditions. Med Care 44 (2006), 900–907.
13. 13 Landon, B.E., Zaslavsky, A.M., Saunders, R., et al. A comparison of relative resource use and quality in Medicare Advantage health plans versus traditional Medicare. Am J Manag Care 21 (2015), 559–566.
14. 14 Angelelli, J.J., Wilber, K.H., Myrtle, R., A comparison of skilled nursing facility rehabilitation treatment and outcomes under Medicare managed care and Medicare fee-for-service reimbursement. Gerontologist 40 (2000), 646–653.
15. 15 Leach, L.S., Yip, J.Y., Myrtle, R.C., Wilber, K.H., Outcomes among orthopedic patients in skilled nursing facilities: Does managed care make a difference?. J Nurs Adm 31 (2001), 527–533.
16. 16 Mechanic, R., Post-acute care—The next frontier for controlling Medicare spending. N Engl J Med 370 (2014), 692–694.
17. 17 Burke, R.E., Juarez-Colunga, E., Levy, C., et al. Rise of post-acute care facilities as a discharge destination of US hospitalizations. JAMA Intern Med 175 (2015), 295–296.
18. 18 Mukamel, D.B., Spector, W.D., Zinn, J., et al. Changes in clinical and hotel expenditures following publication of the nursing home compare report card. Med Care 48 (2010), 869–874.
19. 19 Bostick, J.E., Rantz, M.J., Flesner, M.K., et al. Systematic review of studies of staffing and quality in nursing homes. J Am Med Dir Assoc 7 (2006), 366–376.
20. 20 Hunt, S.R., Corazzini, K., Anderson, R.A., Top nurse-management staffing collapse and care quality in nursing homes. J Appl Gerontol 33 (2014), 51–74.
21. 21 Hickey, E.C., Young, G.J., Parker, V.A., et al. The effects of changes in nursing home staffing on pressure ulcer rates. J Am Med Dir Assoc 6 (2005), 50–53.
22. 22 Afendulis, C.C., Caudry, D.J., O'Malley, A.J., et al. Green house adoption and nursing home quality. Health Serv Res 51:Suppl 1 (2016), 454–474.
23. 23 Backhaus, R., Verbeek, H., van Rossum, E., et al. Nurse staffing impact on quality of care in nursing homes: A systematic review of longitudinal studies. J Am Med Dir Assoc 15 (2014), 383–393.
24. 24 Lima, J.C., Intrator, O., Karuza, J., et al. Nursing home medical staff organization and 30-day rehospitalizations. J Am Med Dir Assoc 13 (2012), 552–557.
25. 25 Lima, J.C., Intrator, O., Wetle, T., Physicians in nursing homes: Effectiveness of physician accountability and communication. J Am Med Dir Assoc 16 (2015), 755–761.
26. 26 Comondore, V.R., Devereaux, P.J., Zhou, Q., et al. Quality of care in for-profit and not-for-profit nursing homes: Systematic review and meta-analysis. BMJ, 339, 2009, b2732.
27. 27 Grabowski, D.C., Feng, Z., Hirth, R., et al. Effect of nursing home ownership on the quality of post-acute care: An instrumental variables approach. J Health Econ 32 (2013), 12–21.
28. 28 Cai, S.B., Mukamel, D.B., Veazie, P., et al. Hospitalizations in nursing homes: Does payer source matter? Evidence from New York State. Med Care Res Rev 68 (2011), 559–578.
29. 29 Rahman, M., Grabowski, D.C., Gozalo, P.L., et al. Are dual eligibles admitted to poorer quality skilled nursing facilities?. Health Serv Res 49 (2014), 798–817.
30. 30 King, B.J., Gilmore-Bykovskyi, A.L., Roiland, R.A., et al. The consequences of poor communication during transitions from hospital to skilled nursing facility: A qualitative study. J Am Geriatr Soc 61 (2013), 1095–1102.
31. 31 Potthoff, S., Kane, R.L., Franco, S.J., Improving hospital discharge planning for elderly patients. Health Care Financ Rev 19 (1997), 47–72.
32. 32 Stevenson, D.G., Ayanian, J.Z., Zaslavsky, A.M., et al. Service use at the end-of-life in Medicare advantage versus traditional Medicare. Med Care 51 (2013), 931–937.
33. 33 Virnig, B.A., Fisher, E.S., McBean, A.M., Kind, S., Hospice use in Medicare managed care and fee-for-service systems. Am J Manag Care 7 (2001), 777–786.
34. 34 McCarthy, E.P., Burns, R.B., Ngo-Metzger, Q., et al. Hospice use among Medicare managed care and fee-for-service patients dying with cancer. JAMA 289 (2003), 2238–2245.
35. 35 Pope, G.C., Kautter, J., Ellis, R.P., et al. Risk adjustment of Medicare capitation payments using the CMS-HCC model. Health Care Financ Rev 25 (2004), 119–141.
36. 36 Li, P., Kim, M.M., Doshi, J.A., Comparison of the performance of the CMS Hierarchical Condition Category (CMS-HCC) risk adjuster with the Charlson and Elixhauser comorbidity measures in predicting mortality. BMC Health Serv Res, 10, 2010, 245.
37. 37 RTI International. MDS 3.0 Quality Measures user's manual (v6.0). Available at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIQualityMeasures.html. Accessed April 23, 2014.
38. 38 Zou, G., A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 159 (2004), 702–706.
39. 39 Song, Y., Skinner, J., Bynum, J., et al. Regional variations in diagnostic practices. N Engl J Med 363 (2010), 45–53.
40. 40 Zinn, J.S., Mor, V., Castle, N., et al. Organizational and environmental factors associated with nursing home participation in managed care. Health Serv Res 33 (1999), 1753–1767.
41. 41 Nicholas, L.H., Better quality of care or healthier patients? Hospital utilization by Medicare Advantage and fee-for-service enrollees. Forum Health Econ Policy 16 (2013), 137–161.
42. 42 Landon, B.E., Zaslavsky, A.M., Saunders, R.C., et al. Analysis of Medicare Advantage HMOs compared with traditional Medicare shows lower use of many services during 2003-09. Health Aff 31 (2012), 2609–2617.
43. 43 Ayanian, J.Z., Landon, B.E., Zaslavsky, A.M., et al. Medicare beneficiaries more likely to receive appropriate ambulatory services in HMOs than in traditional Medicare. Health Aff 32 (2013), 1228–1235.
44. 44 Rahman, M., Tyler, D., Thomas, K.S., et al. Higher Medicare SNF care utilization by dual-eligible beneficiaries: Can Medicaid long-term care policies be the answer?. Health Serv Res 50 (2015), 161–179.
45. 45 Rahman, M., Keohane, L., Trivedi, A.N., et al. High-cost patients had substantial rates of leaving Medicare Advantage and joining traditional Medicare. Health Aff 34 (2015), 1675–1681.
46. 46 Gold, M., Medicare's private plans: A report card on Medicare Advantage. Health Aff 28 (2009), w41–w54.
47. 47 Medicare Payment Advisory Commission. Chapter 14: Medicare Advantage Special Needs Plans. Report to the Congress: Medicare Payment Policy. Available at: http://www.medpac.gov/documents/reports/chapter-14-medicare-advantage-special-needs-plans-(march-2013-report).pdf?sfvrsn=2, March 2013 Accessed July 5, 2016.
48. 48 Grabowski, D.C., Special Needs Plans and the coordination of benefits and services for dual eligibles. Health Aff 28 (2009), 136–146.
49. 49 Miller, M.E., Medicare post-acute reforms. Medicare Payment Advisory Commission testimony. Available at: http://www.medpac.gov/documents/20130614_WandM_Testimony_PAC.pdf, June 14, 2013 Accessed April 23, 2014.
50. 50 Mukamel, D.B., Weimer, D.L., Harrington, C., et al. The effect of state regulatory stringency on nursing home quality. Health Serv Res 47 (2012), 1791–1813.
51. 51 Centers for Medicare & Medicaid Services. CMS adds new quality measures to Nursing Home Compare. Available at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-04-27.html. Published online April 27, 2016. Accessed June 24, 2016.