Logo image
Back
Effects of Medicare advantage on patterns of end‐of‐life care among Medicare decedents
Journal article   Open access   Peer reviewed

Effects of Medicare advantage on patterns of end‐of‐life care among Medicare decedents

Sungchul Park, Joan M. Teno, Lindsay White and Norma B. Coe
Health services research, v 57(4), pp 863-871
Aug 2022
DOI: https://doi.org/10.1111/1475-6773.13953
PMID: 35156205
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1111/1475-6773.13953View
Published, Version of Record (VoR)Open Access (License Unspecified),  Open

Abstract

end‐of‐life care hospice Medicare advantage traditional Medicare
Objective To examine the effects of Medicare Advantage (MA) enrollment on patterns of end‐of‐life care. Data sources We used data from the Master Beneficiary Summary File, the Medicare Provider Analysis and Review, hospice claims, the Minimum Data Set, the Outcome and Assessment Information Set, the Area Health Resources File, and Geographic Variation Public Use File for 2012–2014. Study design To address selective enrollment into MA, we exploited a discontinuity in payment rates by county population (urban floor payments) as an instrument. Data collection/extraction methods We identified Medicare beneficiaries continuously enrolled in MA or TM during their last year of life between 2012 and 2014 using Medicare administrative data. Principal findings We did not find evidence that MA enrollment led to a change in hospital admissions in the last 30 days of life, but MA enrollment decreased hospital as the site of death by 11.0 (95% CI: −13.9 to −8.1) percentage points. Once hospitalized, however, MA enrollment increased use of intensive care by 6.7 (95% CI: 0.3 to 13.1) percentage points and non‐invasive mechanical ventilation by 9.2 (95% CI: 5.5 to 12.9) percentage points. MA enrollment increased hospice use by 6.2 (95% CI: 2.3 to 10.1) percentage points at time of death and 7.7 (95% CI: 3.8 to 11.6) percentage points in the last 30 days of life. Particularly, MA enrollment increased hospice admissions among those who were admitted to the hospital within 30 days prior to hospice admission by 18.8 (95% CI: 13.8 to 23.8) percentage points. However, MA enrollment decreased hospice admissions among those who were admitted to home health within 30 days prior to hospice admission by 18.6 (95% CI: −21.9 to −15.2) percentage points. Conclusions MA plans may improve end‐of‐life care by reducing hospital death while also improving access to hospice, especially among recently hospitalized persons.

Metrics

23 Record Views
7 citations in Web of Science
4 citations in Scopus

Details

UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

InCites Highlights

Data related to this publication, from InCites Benchmarking & Analytics tool:

Collaboration types
Domestic collaboration
Web of Science research areas
Health Care Sciences & Services
Health Policy & Services
Logo image