Reducing has been a quality measure which has recently received significant attention as a way to potentially decrease our nations healthcare expenditures. By improving outpatient resources and ensuring continuity of care after discharge, policymakers hope to decrease preventable readmissions.
There are some encouraging signs of progress in this regard; the overall rate of readmissions dropped from 20% to 17.5% after among traditional Medicare beneficiaries. Despite this progress, data have shown that racial disparities exists in readmission rates with within 30 days compared to Whites. In this study the authors aimed to determine whether these disparities persisted amongst patients enrolled in Medicare Advantage plans versus traditional fee-for-service Medicare.
The authors studied 30-day hospital readmission rates among Medicare and Medicare Advantage patients in New York state who were admitted for acute myocardial infarction (heart attacks), congestive heart failure, or pneumonia between 2009 and 2012. They compared readmission rates based on racial and ethnic designations of non Hispanic White, Black, and Hispanic. Other races were excluded from this study.
As seen in previous studies, rates of 30-day readmission declined from 22.0% to 20.7% in the study period among traditional Medicare patients and from 20.2% to 17.9% among Medicare Advantage beneficiaries. Even though there was an overall decrease in readmission rates, Black patients with traditional Medicare had higher readmission rates than their counterparts of other racial designations regardless of insurance status, co-morbidities, health status, and hospital characteristics. Medicare Advantage patients had lower rates of readmission overall and the racial disparity noted in traditional Medicare patients disappeared in the Medicare Advantage cohort. No ethnic disparities were observed in either group of patients.
In a healthcare system where disparities abound, it is encouraging to see that some can be reduced, if not eliminated altogether. Medicare Advantage programs have significant financial interests to ensure that their participants have access to outpatient medical care and other resources vital to preventing readmissions. These incentives provide an impetus for healthcare providers and insurers to address patient needs and to improve health outcomes regardless of the patients race. Hopefully, broader implementation of these personalized and targeted initiatives will continue to improve individual and population health, as well as reduce national healthcare expenditures.
commentary by Vidya Eswaran
This study determined potential racial and ethnic disparities in risk for all-cause 30- day readmission among traditional Medicare (TM) and Medicare Advantage (MA) beneficiaries initially hospitalized for acute myocardial infarction, congestive heart failure, or pneumonia. Our analyses of New York State hospital administrative data between 2009 and 2012 found that overall 30-day readmission rate declined from 22.0% in 2009 to 20.7% in 2012 for TM beneficiaries, and from 20.2% in 2009 to 17.9% in 2012 for MA beneficiaries. However, persistent racial disparities were found in propensity scorebased analyses among TM beneficiaries (e.g., in 2012, adjusted odds ratio [OR] = 1.11, 95% confidence interval [CI] = 1.01-1.23, p = .029), though not among MA beneficiaries (in 2012, adjusted OR = 1.05, 95% CI = 0.92-1.19, p = .476). We did not find evidence of persistent ethnic disparity for TM (in 2012, adjusted OR = 1.08, 95% CI = 0.93-1.25, p = .303) or MA (in 2012, adjusted OR = 0.99, 95% CI = 0.88-1.11, p = .837) beneficiaries. We conclude that enrollment in MA seemed to be associated with significantly reduced readmission rate and potentially reduced racial disparity. PMID: 27927839