Quality of care and in-hospital mortality were found to be comparable for patients with heart failure (HF) who were covered by Medicare Advantage (MA) or fee-for-service (FFS) Medicare, according to a retrospective cohort study published in JAMA Cardiology.
Data from 262,626 adult patients with Medicare who were hospitalized for HF between 2014 and 2018 were collected from the Get With the Guidelines-Heart Failure registry. Patients were assessed for in-hospital mortality, status at discharge, length of hospital stay, and HF achievement measurements.
Most of the patients in this cohort were enrolled in FFS Medicare (64.4%). Patients were treated at 569 sites across the United States, with an average number of 461.6±575.3 hospitalizations per site. Age, gender, demographic, ejection fraction, and comorbidities were comparable for patients enrolled in FFS and MA (standard difference <0.01). At hospital admission, patients did not differ for vital signs, lipid levels, or laboratory measures (ie, standard mean difference <10%).
Patient demographics and burden associated with comorbidities were comparable, on average, in patients enrolled in MA vs FFS, although patients with MA vs FFS were more likely to have comorbidities and less likely to be women and White.
Patients with MA vs FFS were more likely to be admitted to a hospital in the Midwest (26.4% vs 21.2%, respectively; P <.001).
Patients with MA vs FFS were more likely to be discharged home (72.8% vs 69.8%, respectively; adjusted odds ratio [aOR], 1.16; 95% CI, 1.13-1.19; P <.001) and less likely to be discharged to inpatient rehabilitation facilities (1.9% vs 3.2%, respectively; P <.001) or skilled nursing facilities (16.1% vs 17.5%, respectively; P <.001). Patients with MA vs FFS were less likely to be discharged within 4 days (aOR, 0.97; 95% CI, 0.93-1.00; P =.04).
The majority of quality measures were comparable for patients enrolled in MA vs FFS, however, patients with MA vs FFS were more likely to receive anticoagulation therapy for atrial fibrillation or atrial flutter (aOR, 1.13; 95% CI, 1.06-1.21; P <.001) and to receive discharge instructions (aOR, 1.11; 95% CI, 1.103-1.20; P =.008). Patient mortality did not differ based on insurance (MA: 2.9% vs FFS: 3.0%; P =.05).
A limitation of this study was that only in-hospital data were available. It remains unclear whether 30-day mortality or readmission rates were similar between Medicare groups.
“[W]e found no meaningful differences in the characteristics of patients or the quality of care received between those enrolled in MA vs those enrolled in FFS Medicare,” noted the study authors. “The main influence of MA appears to be limiting the use of post-acute care facilities, which is likely a utilization management strategy aimed at reducing costs.”
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Figueroa J F, Wadhera R K, Frakt A B, et al. Quality of care and outcomes among Medicare advantage vs fee-for-Service Medicare patients hospitalized with heart failure. [published online September 2, 2020] JAMA Cardiol. doi:10.1001/jamacardio.2020.3638