Medicare advantage enrollees more likely to enter lower- quality nursing homes compared to fee-for-service enrollees

Health Affairs

Volumn 37, Issue 1, 2018, Pages 78-85

  Meyers, David J ^a   Mor, Vincent ^a,b   Rahman, Momotazur ^a  

^a BROWN UNIVERSITY   (United States)

^b PROVIDENCE VETERANS AFFAIRS MEDICAL CENTER   (United States)

Author keywords

Insurance; Long term care; Managed care Medicare < managed care; Medicare; Quality of care

Indexed keywords

ADULT; ARTICLE; CONTROLLED STUDY; HOSPITAL READMISSION; HUMAN; LONG TERM CARE; MANAGED CARE; MEDICARE; NEIGHBORHOOD; NURSING HOME; PROBABILITY; AGED; FACTUAL DATABASE; HEALTH CARE QUALITY; STANDARDS; STATISTICS AND NUMERICAL DATA; UNITED STATES; VERY ELDERLY;

AGED; AGED, 80 AND OVER; DATABASES, FACTUAL; HUMANS; MEDICARE; MEDICARE PART C; NURSING HOMES; PATIENT READMISSION; QUALITY INDICATORS, HEALTH CARE; UNITED STATES;

EID: 85046819800     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2017.0714     Document Type: Article

References (44)

1. Jacobson G, Casillas G, Damico A, Neuman T, Gold M. Medicare Advantage 2016 spotlight: enrollment market update [Internet]. Menlo Park (CA): Henry J. Kaiser Family Foundation; 2016 May 11 [cited 2017 Nov 13]. (Issue Brief). Available from: http://kff.org/medicare/issuebrief/ medicare-advantage-2016-spotlight-enrollment-marketupdate/
2. Robinson JC, Phibbs CS. An evaluation of Medicaid selective contracting in California. J Health Econ. 1989;8(4):437-55
3. Gruber J, McKnight R. Controlling health care costs through limited network insurance plans: evidence from Massachusetts state employees [Internet]. Cambridge (MA): National Bureau of Economic Research; 2014 Sep [cited 2017 Nov 13]. (NBER Working Paper No. 20462). Available from: http://www.nber.org/ papers/w20462.pdf
4. Shepard M. Hospital network competition and adverse selection: evidence from the Massachusetts health insurance exchange [Internet]. Cambridge (MA): National Bureau of Economic Research; 2016 Sep [cited 2017 Nov 13]. (NBER Working Paper No. 22600). Available from: http://www.nber.org/ papers/w22600.pdf
5. Polsky D, Weiner J. The skinny on narrow networks in health insurance marketplace plans [Internet]. Philadelphia (PA): University of Pennsylvania, Leonard Davis Institute of Health Economics; 2015 Jun 23 [cited 2017 Nov 13]. (Data Brief). Available from: http://repository .upenn.edu/cgi/viewcontent.cgi? article=1002&context=ldi_ databriefs
6. Robinson JC. Hospital tiers in health insurance: balancing consumer choice with financial incentives. Health Aff (Millwood). 2003; (Suppl Web Exclusives):W3-135-46
7. Lindrooth RC, Norton EC, Dickey B. Provider selection, bargaining, and utilization management in managed care. Econ Inq. 2002;40(3):348-65
8. Chernew ME, Fendrick AM. Improving benefit design to promote effective, efficient, and affordable care. JAMA. 2016;316(16):1651-2
9. Jacobson G, Trilling A, Neuman T, Damico A, Gold M. Medicare Advantage hospital networks: how much do they vary? [Internet]. Menlo Park (CA): Henry J. Kaiser Family Foundation; 2016 Jun [cited 2017 Nov 13]. Available from: http:// insurance.maryland.gov/Consumer/ Documents/agencyhearings/Kaiser Report-Medicare-Advantage-Hospital-Networks-How-Much-Do-They-Vary.pdf
10. Pear R. Lower health insurance premiums to come at cost of fewer choices. New York Times. 2013 Sep 22
11. Medicare Payment Advisory Commission. Report to the Congress: Medicare Payment Policy [Internet]. 2017 Mar. Available from: http:// medpac.gov/docs/default-source/ reports/mar17_entirereport.pdf
12. Rahman M, Foster AD. Racial segregation and quality of care disparity in US nursing homes. J Health Econ. 2015;39:1-16
13. Schoenfeld AJ, Zhang X, Grabowski DC, Mor V, Weissman JS, Rahman M. Hospital-skilled nursing facility referral linkage reduces readmission rates among Medicare patients receiving major surgery. Surgery. 2016;159(5):1461-8
14. Kane RA, Kling KC, Bershadsky B, Kane RL, Giles K, Degenholtz HB, et al. Quality of life measures for nursing home residents. J Gerontol A Biol Sci Med Sci. 2003;58(3): 240-8
15. Smith DB, Feng Z, Fennell ML, Zinn JS, Mor V. Separate and unequal: racial segregation and disparities in quality across U.S. nursing homes. Health Aff (Millwood). 2007;26(5): 1448-58
16. Mor V, Zinn J, Angelelli J, Teno JM, Miller SC. Driven to tiers: socioeconomic and racial disparities in the quality of nursing home care. Milbank Q. 2004;82(2):227-56
17. Rahman M, Keohane L, Trivedi AN, Mor V. High-cost patients had substantial rates of leaving Medicare Advantage and joining traditional Medicare. Health Aff (Millwood). 2015;34(10):1675-81
18. Gambassi G, Landi F, Peng L, Brostrup-Jensen C, Calore K, Hiris J, et al. Validity of diagnostic and drug data in standardized nursing home resident assessments: potential for geriatric pharmacoepidemiology. SAGE Study Group. Systematic Assessment of Geriatric drug use via Epidemiology. Med Care. 1998; 36(2):167-79
19. Mor V. A comprehensive clinical assessment tool to inform policy and practice: applications of the Minimum Data Set. Med Care. 2004; 42(4, Suppl):III50-9
20. Landi F, Tua E, Onder G, Carrara B, Sgadari A, Rinaldi C, et al. Minimum Data Set for home care: a valid instrument to assess frail older people living in the community. Med Care. 2000;38(12):1184-90
21. Mor V, Berg K, Angelelli J, Gifford D, Morris J, Moore T. The quality of quality measurement in U.S. nursing homes. Gerontologist. 2003; 43(Spec No 2):37-46
22. Trivedi AN, Zaslavsky AM, Schneider EC, Ayanian JZ. Trends in the quality of care and racial disparities in Medicare managed care. N Engl J Med. 2005;353(7): 692-700
23. CMS.gov. Part C and D performance data [Internet]. Baltimore (MD): Centers for Medicare and Medicaid Services; [last modified 2017 Nov 2; cited 2017 Nov 13]. Available from: https://www.cms.gov/Medicare/ Prescription-Drug-Coverage/ PrescriptionDrugCovGenIn/ PerformanceData.html
24. LTCfocus [home page on the Internet]. Providence (RI): Brown University; [cited 2017 Nov 13]. Available from: http://ltcfocus.org/
25. Medicare.gov. About Nursing Home Compare Data[Internet]. Baltimore (MD): Centers for Medicare and Medicaid Services; [cited 2017 Nov 13]. Available from: https://www .medicare.gov/NursingHome Compare/Data/About.html
26. Schapira MM, Shea JA, Duey KA, Kleiman C, Werner RM. The Nursing Home Compare report card: perceptions of residents and caregivers regarding quality ratings and nursing home choice. Health Serv Res. 2016;51(Suppl 2):1212-28
27. Neuman MD, Wirtalla C, Werner RM. Association between skilled nursing facility quality indicators and hospital readmissions. JAMA. 2014; 312(15):1542-51
28. Konetzka RT, Polsky D, Werner RM. Shipping out instead of shaping up: rehospitalization from nursing homes as an unintended effect of public reporting. J Health Econ. 2013;32(2):341-52
29. Konetzka RT, Grabowski DC, Perraillon MC, Werner RM. Nursing home 5-star rating system exacerbates disparities in quality, by payer source. Health Aff (Millwood). 2015; 34(5):819-27
30. Werner RM, Norton EC, Konetzka RT, Polsky D. Do consumers respond to publicly reported quality information? Evidence from nursing homes. J Health Econ. 2012;31(1): 50-61
31. Dulal R. Cost efficiency of nursing homes: do five-star quality ratings matter? Health Care Manag Sci. 2017;20(3):316-25
32. Rahman M, Grabowski DC, Mor V, Norton EC. Is a skilled nursing facility's rehospitalization rate a valid quality measure? Health Serv Res. 2016;51(6):2158-75
33. Morris JN, Fries BE, Morris SA. Scaling ADLs within the MDS. J Gerontol A Biol Sci Med Sci. 1999; 54(11):M546-53
34. Thomas KS, Dosa D, Wysocki A, Mor V. The Minimum Data Set 3.0 Cognitive Function Scale. Med Care. 2017;55(9):e68-72
35. Rahman M, Foster AD, Grabowski DC, Zinn JS, Mor V. Effect of hospital-SNF referral linkages on rehospitalization. Health Serv Res. 2013;48(6 Pt 1):1898-919
36. Robusto CC. The cosine-haversine formula. Am Math Mon. 1957; 64(1):38-40
37. McFadden D. Conditional logit analysis of qualitative choice behavior. In: Zarembka P, editor. Frontiers in econometrics. New York (NY): Academic Press; 1974. p. 105-42
38. McFadden D. Modeling the choice of residential location. In: Karlqvist A, Lundqvist L, Snickars F, Weibull J, editors. Spatial interaction theory and planning models. Amsterdam: North Holland; 1978. p. 75-96
39. To access the appendix, click on the Details tab of the article online
40. Chang E, Ruder T, Setodji C, Saliba D, Hanson M, Zingmond DS, et al. Differences in nursing home quality between Medicare Advantage and traditional Medicare patients. J Am Med Dir Assoc. 2016;17(10): 960.e9-14
41. Tyler DA, Gadbois EA, McHugh JP, Shield RR, Winblad U, Mor V. Patients are not given quality-of-care data about skilled nursing facilities when discharged from hospitals. Health Aff (Millwood). 2017;36(8): 1385-91
42. Mukamel DB. Risk-adjusted outcome measures and quality of care in nursing homes. Med Care. 1997; 35(4):367-85
43. Intrator O, Zinn J, Mor V. Nursing home characteristics and potentially preventable hospitalizations of longstay residents. J Am Geriatr Soc. 2004;52(10):1730-6
44. Intrator O, Grabowski DC, Zinn J, Schleinitz M, Feng Z, Miller S, et al. Hospitalization of nursing home residents: the effects of states' Medicaid payment and bed-hold policies. Health Serv Res. 2007; 42(4):1651-71