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Quality of Care and Outcomes Among Medicare Advantage vs Fee-for-Service Medicare Patients Hospitalized With Heart Failure JAMA CARDIOLOGY Figueroa, J. F., Wadhera, R. K., Frakt, A. B., Fonarow, G. C., Heidenreich, P. A., Xu, H., Lytle, B., DeVore, A. D., Matsouaka, R., Yancy, C. W., Bhatt, D. L., Maddox, K. 2020; 5 (12): 1349-1357

Abstract

Medicare Advantage (MA), a private insurance plan option, now covers one-third of all Medicare beneficiaries. Although patients with cardiovascular disease enrolled in MA have been reported to receive higher quality of care in the ambulatory setting than patients enrolled in fee-for-service (FFS) Medicare, it is unclear whether MA is associated with higher quality in patients hospitalized with heart failure, or alternatively, if incentives to reduce utilization under MA plans may be associated with worse care.To determine whether there are differences in quality of care received and in-hospital outcomes among patients enrolled in MA vs FFS Medicare.Observational, retrospective cohort study of patients hospitalized with heart failure in hospitals participating in the Get With the Guidelines-Heart Failure registry.Medicare Advantage enrollment.In-hospital mortality, discharge disposition, length of stay, and 4 heart failure achievement measures.Of 262?626 patients hospitalized with heart failure, 93?549 (35.6%) were enrolled in MA and 169?077 (64.4%) in FFS Medicare. The median (interquartile range) age was 78 (70-85) years for patients enrolled in MA and 78 (69-86) years for patients enrolled in FFS Medicare. Standard mean differences in age, sex, prevalence of comorbidities, or objective measures on admission, including vital signs and laboratory values, were less than 10%. After adjustment, there were no statistically significant differences in receipt of evidence-based ß-blockers when indicated; angiotensin-converting enzyme inhibitor, angiotensin II receptor blockers, or angiotensin receptor-neprilysin inhibitors at discharge; measurement of left ventricular function; and postdischarge appointments by Medicare insurance type. Patients enrolled in MA, however, had higher odds of being discharged directly home (adjusted odds ratio [AOR], 1.16; 95% CI, 1.13-1.19; P?

View details for DOI 10.1001/jamacardio.2020.3638

View details for Web of Science ID 000604742700001

View details for PubMedID 32876650

View details for PubMedCentralID PMC7489427