Medicare Advantage affects readmission/mortality ranking of top-performing hospitals

A US study reports about one in four top-performing hospitals being reclassified to a lower performance group when Medicare Advantage (MA) beneficiaries are included in the assessment of hospital readmission and mortality.

Likewise, several hospitals have been reclassified to a higher performance ranking with the inclusion of MA beneficiaries.

“Medicare links hospital performance on readmissions and mortality to payment solely on the basis of outcomes among fee-for-service (FFS) beneficiaries,” said the researchers, who conducted a population-based, cross-sectional study to determine whether including MA beneficiaries in readmission and mortality measures reclassified hospital performance rankings compared with current measures.

The research team used the 100-percent Medicare files for FFS and MA claims to calculate 30-day risk-adjusted readmissions and mortality for acute myocardial infarction, heart failure, chronic obstructive pulmonary disease, and pneumonia based on FFS beneficiaries only and then both FFS and MA beneficiaries.

Hospitals participating in the Hospital Readmissions Reduction Program or Hospital Value-Based Purchasing Program were divided into quintiles of performance based on FFS beneficiaries only. The researchers then calculated the number of hospitals reclassified to a different performance group with the inclusion of MA beneficiaries.

Between 21.6 percent and 30.2 percent of hospitals in the top-performing quintile for readmissions and mortality based on FFS beneficiaries were reclassified to a lower-performing quintile when MA beneficiaries were included.

Likewise, similar proportions of hospitals had been reclassified from the bottom performance quintile to a higher one across all measures and conditions. Hospitals with a higher proportion of MA beneficiaries had a higher likelihood of improving in performance rankings.

“These findings suggest that Medicare's current value-based programs provide an incomplete picture of hospital performance,” the researchers said.

The study was limited by the use of hospital performance measurement and risk adjustment that differed slightly from those used by Medicare.