Abstract

Importance  Unlike traditional Medicare (TM), Medicare Advantage (MA) plans limit in-network care to a specific network of Medicare clinicians. MA plans thus play a role in sorting patients to a subset of clinicians. It is unknown whether the performance of physicians who treat MA and TM beneficiaries is different.

Objective  To examine whether avoidable hospital stay differences between MA and TM can be explained by the primary care clinicians who treat MA and TM beneficiaries.

Design, Setting, and Participants  This was a cross-sectional study of a nationally representative sample of MA and TM beneficiaries in 2019 with any of 5 chronic ambulatory care–sensitive conditions (ACSCs). The relative risk (RR) of avoidable hospital stays in MA compared with TM was estimated with inverse probability of treatment-weighted Poisson regression, both without and with clinician fixed effects. The degree to which the estimated MA vs TM difference could be explained by patient sorting was calculated by comparing the 2 RR estimates. Data were analyzed between February 2022 and April 2023.

 

Citation

Xu J, Anderson KE, Liu A, Miller BJ, Polsky D. Role of Patient Sorting in Avoidable Hospital Stays in Medicare Advantage vs Traditional Medicare. JAMA Health Forum. 2023;4(11):e233931. doi:10.1001/jamahealthforum.2023.3931