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<video-js
class="vjs-fluid video-js vjs-paused vjs-controls-enabled vjs-workinghover vjs-v8 vjs-user-active vjs-layout-x-small bc-player-YGTlZfnIMm_default bc-player-YGTlZfnIMm_default-index-0 vjs-mouse vjs-plugins-ready vjs-player-info vjs-contextmenu-ui vjs-viewability vjs-errors"
data-account="864352215001" data-application-id="" data-embed="default" data-player="YGTlZfnIMm" data-playlist-id="" data-video-id="6362812912112" height="476.44" width="268" id="vjs_video_3" tabindex="-1" lang="en"
translate="no" role="region" aria-label="Video Player"><video tabindex="-1" id="vjs_video_3_html5_api" data-video-id="6362812912112" data-playlist-id="" data-player="YGTlZfnIMm" data-embed="default"
data-application-id="" data-account="864352215001" class="vjs-tech"
poster="https://cf-images.us-east-1.prod.boltdns.net/v1/static/864352215001/be0a1926-64b9-4a85-abc4-16dd2fdb6081/e7b3d957-7f76-4d35-b6a0-30fc43148d62/1280x720/match/image.jpg"
src="blob:https://jamanetwork.com/600876a6-4a20-4cff-b04b-f530a0947068" data-blueconic-media-listener="true" width="268" height="476"></video>
<div class="vjs-poster" aria-disabled="false">
<picture class="vjs-poster" tabindex="-1"><img loading="lazy" alt=""
src="https://cf-images.us-east-1.prod.boltdns.net/v1/static/864352215001/be0a1926-64b9-4a85-abc4-16dd2fdb6081/e7b3d957-7f76-4d35-b6a0-30fc43148d62/1280x720/match/image.jpg"></picture>
</div>
<div class="vjs-title-bar vjs-hidden">
<div class="vjs-title-bar-title" id="vjs-title-bar-title-92"></div>
<div class="vjs-title-bar-description" id="vjs-title-bar-description-93"></div>
</div>
<div class="vjs-text-track-display" translate="yes" aria-live="off" aria-atomic="true">
<div style="position: absolute; inset: 0px; margin: 1.5%;"></div>
</div>
<div class="vjs-loading-spinner" dir="ltr"><span class="vjs-control-text">Video Player is loading.</span></div><button class="vjs-big-play-button" type="button" title="Play Video" aria-disabled="false"><span
class="vjs-icon-placeholder" aria-hidden="true"></span><span class="vjs-control-text" aria-live="polite">Play Video</span></button>
<div class="vjs-control-bar" dir="ltr"><button class="vjs-play-control vjs-control vjs-button" type="button" title="Play" aria-disabled="false"><span class="vjs-icon-placeholder" aria-hidden="true"></span><span
class="vjs-control-text" aria-live="polite">Play</span></button><button class="vjs-skip-backward-undefined vjs-control vjs-button vjs-hidden" type="button" title="Skip Backward" aria-disabled="false"><span
class="vjs-icon-placeholder" aria-hidden="true"></span><span class="vjs-control-text" aria-live="polite">Skip Backward</span></button><button class="vjs-skip-forward-undefined vjs-control vjs-button vjs-hidden"
type="button" title="Skip Forward" aria-disabled="false"><span class="vjs-icon-placeholder" aria-hidden="true"></span><span class="vjs-control-text" aria-live="polite">Skip Forward</span></button>
<div class="vjs-volume-panel vjs-control vjs-volume-panel-vertical"><button class="vjs-mute-control vjs-control vjs-button vjs-vol-3" type="button" title="Mute" aria-disabled="false"><span class="vjs-icon-placeholder"
aria-hidden="true"></span><span class="vjs-control-text" aria-live="polite">Mute</span></button>
<div class="vjs-volume-control vjs-control vjs-volume-vertical">
<div tabindex="0" class="vjs-volume-bar vjs-slider-bar vjs-slider vjs-slider-vertical" role="slider" aria-valuenow="100" aria-valuemin="0" aria-valuemax="100" aria-label="Volume Level" aria-live="polite"
aria-valuetext="100%">
<div class="vjs-mouse-display">
<div class="vjs-volume-tooltip" aria-hidden="true"></div>
</div>
<div class="vjs-volume-level"><span class="vjs-control-text"></span></div>
</div>
</div>
</div>
<div class="vjs-current-time vjs-time-control vjs-control"><span class="vjs-control-text" role="presentation">Current Time </span><span class="vjs-current-time-display" role="presentation">0:00</span></div>
<div class="vjs-time-control vjs-time-divider" aria-hidden="true">
<div><span>/</span></div>
</div>
<div class="vjs-duration vjs-time-control vjs-control"><span class="vjs-control-text" role="presentation">Duration </span><span class="vjs-duration-display" role="presentation">0:59</span></div>
<div class="vjs-progress-control vjs-control">
<div tabindex="0" class="vjs-progress-holder vjs-slider vjs-slider-horizontal" role="slider" aria-valuenow="0.00" aria-valuemin="0" aria-valuemax="100" aria-label="Progress Bar" aria-valuetext="0:00 of 0:59">
<div class="vjs-load-progress" style="width: 16.56%;"><span class="vjs-control-text"><span>Loaded</span>: <span class="vjs-control-text-loaded-percentage">16.56%</span></span>
<div data-start="0.083416" data-end="9.919999" style="left: 0.84%; width: 99.16%;"></div>
</div>
<div class="vjs-mouse-display">
<div class="vjs-time-tooltip" aria-hidden="true"></div>
</div>
<div class="vjs-play-progress vjs-slider-bar" aria-hidden="true" style="width: 0%;">
<div class="vjs-time-tooltip" aria-hidden="true" style="right: 0px;">0:00</div>
</div>
</div>
</div>
<div class="vjs-live-control vjs-control vjs-hidden">
<div class="vjs-live-display" aria-live="off"><span class="vjs-control-text">Stream Type </span>LIVE</div>
</div><button class="vjs-seek-to-live-control vjs-control" type="button" title="Seek to live, currently behind live" aria-disabled="false"><span class="vjs-icon-placeholder" aria-hidden="true"></span><span
class="vjs-control-text" aria-live="polite">Seek to live, currently behind live</span><span class="vjs-seek-to-live-text" aria-hidden="true">LIVE</span></button>
<div class="vjs-remaining-time vjs-time-control vjs-control"><span class="vjs-control-text" role="presentation">Remaining Time </span><span aria-hidden="true">-</span><span class="vjs-remaining-time-display"
role="presentation">0:59</span></div>
<div class="vjs-custom-control-spacer vjs-spacer "> </div>
<div class="vjs-playback-rate vjs-menu-button vjs-menu-button-popup vjs-control vjs-button vjs-hidden">
<div class="vjs-playback-rate-value" id="vjs-playback-rate-value-label-vjs_video_3_component_351">1x</div><button class="vjs-playback-rate vjs-menu-button vjs-menu-button-popup vjs-button" type="button"
aria-disabled="false" title="Playback Rate" aria-haspopup="true" aria-expanded="false" aria-describedby="vjs-playback-rate-value-label-vjs_video_3_component_351"><span class="vjs-icon-placeholder"
aria-hidden="true"></span><span class="vjs-control-text" aria-live="polite">Playback Rate</span></button>
<div class="vjs-menu">
<ul class="vjs-menu-content"></ul>
</div>
</div>
<div class="vjs-chapters-button vjs-menu-button vjs-menu-button-popup vjs-control vjs-button vjs-hidden"><button class="vjs-chapters-button vjs-menu-button vjs-menu-button-popup vjs-button" type="button"
aria-disabled="false" title="Chapters" aria-haspopup="true" aria-expanded="false"><span class="vjs-icon-placeholder" aria-hidden="true"></span><span class="vjs-control-text"
aria-live="polite">Chapters</span></button>
<div class="vjs-menu">
<ul class="vjs-menu-content">
<li class="vjs-menu-title" tabindex="-1">Chapters</li>
</ul>
</div>
</div>
<div class="vjs-descriptions-button vjs-menu-button vjs-menu-button-popup vjs-control vjs-button vjs-hidden"><button class="vjs-descriptions-button vjs-menu-button vjs-menu-button-popup vjs-button" type="button"
aria-disabled="false" title="Descriptions" aria-haspopup="true" aria-expanded="false"><span class="vjs-icon-placeholder" aria-hidden="true"></span><span class="vjs-control-text"
aria-live="polite">Descriptions</span></button>
<div class="vjs-menu">
<ul class="vjs-menu-content">
<li class="vjs-menu-item vjs-selected" tabindex="-1" role="menuitemradio" aria-disabled="false" aria-checked="true"><span class="vjs-menu-item-text">descriptions off</span><span class="vjs-control-text"
aria-live="polite">, selected</span></li>
</ul>
</div>
</div>
<div class="vjs-subs-caps-button vjs-menu-button vjs-menu-button-popup vjs-control vjs-button vjs-hidden"><button class="vjs-subs-caps-button vjs-menu-button vjs-menu-button-popup vjs-button" type="button"
aria-disabled="false" title="Captions" aria-haspopup="true" aria-expanded="false"><span class="vjs-icon-placeholder" aria-hidden="true"></span><span class="vjs-control-text"
aria-live="polite">Captions</span></button>
<div class="vjs-menu">
<ul class="vjs-menu-content">
<li class="vjs-menu-item vjs-texttrack-settings" tabindex="-1" role="menuitem" aria-disabled="false"><span class="vjs-menu-item-text">captions settings</span><span class="vjs-control-text" aria-live="polite">,
opens captions settings dialog</span></li>
<li class="vjs-menu-item vjs-selected" tabindex="-1" role="menuitemradio" aria-disabled="false" aria-checked="true"><span class="vjs-menu-item-text">captions off</span><span class="vjs-control-text"
aria-live="polite">, selected</span></li>
</ul>
</div>
</div>
<div class="vjs-audio-button vjs-menu-button vjs-menu-button-popup vjs-control vjs-button vjs-hidden"><button class="vjs-audio-button vjs-menu-button vjs-menu-button-popup vjs-button" type="button"
aria-disabled="false" title="Audio Track" aria-haspopup="true" aria-expanded="false"><span class="vjs-icon-placeholder" aria-hidden="true"></span><span class="vjs-control-text" aria-live="polite">Audio
Track</span></button>
<div class="vjs-menu">
<ul class="vjs-menu-content">
<li class="vjs-menu-item vjs-selected vjs-main-menu-item" tabindex="-1" role="menuitemradio" aria-disabled="false" aria-checked="true"><span class="vjs-menu-item-text">en (Main)</span><span
class="vjs-control-text" aria-live="polite">, selected</span></li>
</ul>
</div>
</div>
</div>
<div class="vjs-error-display vjs-modal-dialog vjs-hidden " tabindex="-1" aria-describedby="vjs_video_3_component_543_description" aria-hidden="true" aria-label="Modal Window" role="dialog" aria-live="polite">
<p class="vjs-modal-dialog-description vjs-control-text" id="vjs_video_3_component_543_description">This is a modal window.</p>
<div class="vjs-modal-dialog-content" role="document"></div>
</div>
<div class="vjs-modal-dialog vjs-hidden vjs-text-track-settings" tabindex="-1" aria-describedby="vjs_video_3_component_549_description" aria-hidden="true" aria-label="Caption Settings Dialog" role="dialog"
aria-live="polite">
<p class="vjs-modal-dialog-description vjs-control-text" id="vjs_video_3_component_549_description">Beginning of dialog window. Escape will cancel and close the window.</p>
<div class="vjs-modal-dialog-content" role="document">
<div class="vjs-track-settings-colors">
<fieldset class="vjs-fg vjs-track-setting">
<legend id="captions-text-legend-vjs_video_3_component_549">Text</legend><span class="vjs-text-color"><label id="captions-foreground-color-vjs_video_3_component_549" class="vjs-label"
for="vjs_select_576">Color</label><select id="vjs_select_576" aria-labelledby="captions-text-legend-vjs_video_3_component_549 captions-foreground-color-vjs_video_3_component_549">
<option id="captions-foreground-color-vjs_video_3_component_549-White" value="#FFF"
aria-labelledby="captions-text-legend-vjs_video_3_component_549 captions-foreground-color-vjs_video_3_component_549 captions-foreground-color-vjs_video_3_component_549-White">White</option>
<option id="captions-foreground-color-vjs_video_3_component_549-Black" value="#000"
aria-labelledby="captions-text-legend-vjs_video_3_component_549 captions-foreground-color-vjs_video_3_component_549 captions-foreground-color-vjs_video_3_component_549-Black">Black</option>
<option id="captions-foreground-color-vjs_video_3_component_549-Red" value="#F00"
aria-labelledby="captions-text-legend-vjs_video_3_component_549 captions-foreground-color-vjs_video_3_component_549 captions-foreground-color-vjs_video_3_component_549-Red">Red</option>
<option id="captions-foreground-color-vjs_video_3_component_549-Green" value="#0F0"
aria-labelledby="captions-text-legend-vjs_video_3_component_549 captions-foreground-color-vjs_video_3_component_549 captions-foreground-color-vjs_video_3_component_549-Green">Green</option>
<option id="captions-foreground-color-vjs_video_3_component_549-Blue" value="#00F"
aria-labelledby="captions-text-legend-vjs_video_3_component_549 captions-foreground-color-vjs_video_3_component_549 captions-foreground-color-vjs_video_3_component_549-Blue">Blue</option>
<option id="captions-foreground-color-vjs_video_3_component_549-Yellow" value="#FF0"
aria-labelledby="captions-text-legend-vjs_video_3_component_549 captions-foreground-color-vjs_video_3_component_549 captions-foreground-color-vjs_video_3_component_549-Yellow">Yellow</option>
<option id="captions-foreground-color-vjs_video_3_component_549-Magenta" value="#F0F"
aria-labelledby="captions-text-legend-vjs_video_3_component_549 captions-foreground-color-vjs_video_3_component_549 captions-foreground-color-vjs_video_3_component_549-Magenta">Magenta</option>
<option id="captions-foreground-color-vjs_video_3_component_549-Cyan" value="#0FF"
aria-labelledby="captions-text-legend-vjs_video_3_component_549 captions-foreground-color-vjs_video_3_component_549 captions-foreground-color-vjs_video_3_component_549-Cyan">Cyan</option>
</select></span><span class="vjs-text-opacity vjs-opacity"><label id="captions-foreground-opacity-vjs_video_3_component_549" class="vjs-label" for="vjs_select_581">Opacity</label><select id="vjs_select_581"
aria-labelledby="captions-text-legend-vjs_video_3_component_549 captions-foreground-opacity-vjs_video_3_component_549">
<option id="captions-foreground-opacity-vjs_video_3_component_549-Opaque" value="1"
aria-labelledby="captions-text-legend-vjs_video_3_component_549 captions-foreground-opacity-vjs_video_3_component_549 captions-foreground-opacity-vjs_video_3_component_549-Opaque">Opaque</option>
<option id="captions-foreground-opacity-vjs_video_3_component_549-SemiTransparent" value="0.5"
aria-labelledby="captions-text-legend-vjs_video_3_component_549 captions-foreground-opacity-vjs_video_3_component_549 captions-foreground-opacity-vjs_video_3_component_549-SemiTransparent">Semi-Transparent
</option>
</select></span>
</fieldset>
<fieldset class="vjs-bg vjs-track-setting">
<legend id="captions-background-vjs_video_3_component_549">Text Background</legend><span class="vjs-bg-color"><label id="captions-background-color-vjs_video_3_component_549" class="vjs-label"
for="vjs_select_591">Color</label><select id="vjs_select_591" aria-labelledby="captions-background-vjs_video_3_component_549 captions-background-color-vjs_video_3_component_549">
<option id="captions-background-color-vjs_video_3_component_549-Black" value="#000"
aria-labelledby="captions-background-vjs_video_3_component_549 captions-background-color-vjs_video_3_component_549 captions-background-color-vjs_video_3_component_549-Black">Black</option>
<option id="captions-background-color-vjs_video_3_component_549-White" value="#FFF"
aria-labelledby="captions-background-vjs_video_3_component_549 captions-background-color-vjs_video_3_component_549 captions-background-color-vjs_video_3_component_549-White">White</option>
<option id="captions-background-color-vjs_video_3_component_549-Red" value="#F00"
aria-labelledby="captions-background-vjs_video_3_component_549 captions-background-color-vjs_video_3_component_549 captions-background-color-vjs_video_3_component_549-Red">Red</option>
<option id="captions-background-color-vjs_video_3_component_549-Green" value="#0F0"
aria-labelledby="captions-background-vjs_video_3_component_549 captions-background-color-vjs_video_3_component_549 captions-background-color-vjs_video_3_component_549-Green">Green</option>
<option id="captions-background-color-vjs_video_3_component_549-Blue" value="#00F"
aria-labelledby="captions-background-vjs_video_3_component_549 captions-background-color-vjs_video_3_component_549 captions-background-color-vjs_video_3_component_549-Blue">Blue</option>
<option id="captions-background-color-vjs_video_3_component_549-Yellow" value="#FF0"
aria-labelledby="captions-background-vjs_video_3_component_549 captions-background-color-vjs_video_3_component_549 captions-background-color-vjs_video_3_component_549-Yellow">Yellow</option>
<option id="captions-background-color-vjs_video_3_component_549-Magenta" value="#F0F"
aria-labelledby="captions-background-vjs_video_3_component_549 captions-background-color-vjs_video_3_component_549 captions-background-color-vjs_video_3_component_549-Magenta">Magenta</option>
<option id="captions-background-color-vjs_video_3_component_549-Cyan" value="#0FF"
aria-labelledby="captions-background-vjs_video_3_component_549 captions-background-color-vjs_video_3_component_549 captions-background-color-vjs_video_3_component_549-Cyan">Cyan</option>
</select></span><span class="vjs-bg-opacity vjs-opacity"><label id="captions-background-opacity-vjs_video_3_component_549" class="vjs-label" for="vjs_select_596">Opacity</label><select id="vjs_select_596"
aria-labelledby="captions-background-vjs_video_3_component_549 captions-background-opacity-vjs_video_3_component_549">
<option id="captions-background-opacity-vjs_video_3_component_549-Opaque" value="1"
aria-labelledby="captions-background-vjs_video_3_component_549 captions-background-opacity-vjs_video_3_component_549 captions-background-opacity-vjs_video_3_component_549-Opaque">Opaque</option>
<option id="captions-background-opacity-vjs_video_3_component_549-SemiTransparent" value="0.5"
aria-labelledby="captions-background-vjs_video_3_component_549 captions-background-opacity-vjs_video_3_component_549 captions-background-opacity-vjs_video_3_component_549-SemiTransparent">Semi-Transparent
</option>
<option id="captions-background-opacity-vjs_video_3_component_549-Transparent" value="0"
aria-labelledby="captions-background-vjs_video_3_component_549 captions-background-opacity-vjs_video_3_component_549 captions-background-opacity-vjs_video_3_component_549-Transparent">Transparent</option>
</select></span>
</fieldset>
<fieldset class="vjs-window vjs-track-setting">
<legend id="captions-window-vjs_video_3_component_549">Caption Area Background</legend><span class="vjs-window-color"><label id="captions-window-color-vjs_video_3_component_549" class="vjs-label"
for="vjs_select_606">Color</label><select id="vjs_select_606" aria-labelledby="captions-window-vjs_video_3_component_549 captions-window-color-vjs_video_3_component_549">
<option id="captions-window-color-vjs_video_3_component_549-Black" value="#000"
aria-labelledby="captions-window-vjs_video_3_component_549 captions-window-color-vjs_video_3_component_549 captions-window-color-vjs_video_3_component_549-Black">Black</option>
<option id="captions-window-color-vjs_video_3_component_549-White" value="#FFF"
aria-labelledby="captions-window-vjs_video_3_component_549 captions-window-color-vjs_video_3_component_549 captions-window-color-vjs_video_3_component_549-White">White</option>
<option id="captions-window-color-vjs_video_3_component_549-Red" value="#F00"
aria-labelledby="captions-window-vjs_video_3_component_549 captions-window-color-vjs_video_3_component_549 captions-window-color-vjs_video_3_component_549-Red">Red</option>
<option id="captions-window-color-vjs_video_3_component_549-Green" value="#0F0"
aria-labelledby="captions-window-vjs_video_3_component_549 captions-window-color-vjs_video_3_component_549 captions-window-color-vjs_video_3_component_549-Green">Green</option>
<option id="captions-window-color-vjs_video_3_component_549-Blue" value="#00F"
aria-labelledby="captions-window-vjs_video_3_component_549 captions-window-color-vjs_video_3_component_549 captions-window-color-vjs_video_3_component_549-Blue">Blue</option>
<option id="captions-window-color-vjs_video_3_component_549-Yellow" value="#FF0"
aria-labelledby="captions-window-vjs_video_3_component_549 captions-window-color-vjs_video_3_component_549 captions-window-color-vjs_video_3_component_549-Yellow">Yellow</option>
<option id="captions-window-color-vjs_video_3_component_549-Magenta" value="#F0F"
aria-labelledby="captions-window-vjs_video_3_component_549 captions-window-color-vjs_video_3_component_549 captions-window-color-vjs_video_3_component_549-Magenta">Magenta</option>
<option id="captions-window-color-vjs_video_3_component_549-Cyan" value="#0FF"
aria-labelledby="captions-window-vjs_video_3_component_549 captions-window-color-vjs_video_3_component_549 captions-window-color-vjs_video_3_component_549-Cyan">Cyan</option>
</select></span><span class="vjs-window-opacity vjs-opacity"><label id="captions-window-opacity-vjs_video_3_component_549" class="vjs-label" for="vjs_select_611">Opacity</label><select id="vjs_select_611"
aria-labelledby="captions-window-vjs_video_3_component_549 captions-window-opacity-vjs_video_3_component_549">
<option id="captions-window-opacity-vjs_video_3_component_549-Transparent" value="0"
aria-labelledby="captions-window-vjs_video_3_component_549 captions-window-opacity-vjs_video_3_component_549 captions-window-opacity-vjs_video_3_component_549-Transparent">Transparent</option>
<option id="captions-window-opacity-vjs_video_3_component_549-SemiTransparent" value="0.5"
aria-labelledby="captions-window-vjs_video_3_component_549 captions-window-opacity-vjs_video_3_component_549 captions-window-opacity-vjs_video_3_component_549-SemiTransparent">Semi-Transparent</option>
<option id="captions-window-opacity-vjs_video_3_component_549-Opaque" value="1"
aria-labelledby="captions-window-vjs_video_3_component_549 captions-window-opacity-vjs_video_3_component_549 captions-window-opacity-vjs_video_3_component_549-Opaque">Opaque</option>
</select></span>
</fieldset>
</div>
<div class="vjs-track-settings-font">
<fieldset class="vjs-font-percent vjs-track-setting">
<legend id="captions-font-size-vjs_video_3_component_549">Font Size</legend><select id="vjs_select_626" aria-labelledby="captions-font-size-vjs_video_3_component_549">
<option id="vjs-track-option-627-50" value="0.50" aria-labelledby="captions-font-size-vjs_video_3_component_549 vjs-track-option-627-50">50%</option>
<option id="vjs-track-option-628-75" value="0.75" aria-labelledby="captions-font-size-vjs_video_3_component_549 vjs-track-option-628-75">75%</option>
<option id="vjs-track-option-629-100" value="1.00" aria-labelledby="captions-font-size-vjs_video_3_component_549 vjs-track-option-629-100">100%</option>
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<div class="figure-label">Figure. Adjusted Medicare Advantage (MA) Coverage, Postacute Care Use, and Patient Outcomes, 2015-2016</div><a id="aoi230101f1" class="figure-table-anchor"> </a>
<div class="figure-table-links right">
<a class="view-large figure-table-link is-b desktop-only" path-from-xml="aoi230101f1" href="https://cdn.jamanetwork.com/ama/content_public/journal/jama-health-forum/939314/aoi230101f1_1707259166.65766.png?Expires=1732031493&Signature=XQV7wJpJUQHyd3gEXeTq1gRw2QvbgGaYRBdFvgg~xCWctV3ZShgHGP5DJ4hOOt3uQf3Mosba91OIEriJLNlv3IQhnvqA8052aYGPZPPzlemCthtkJJYJJokBIWSPDV2Nd1OoqXfffuD7B7CtQMk9edKz6kO3FqylS6af3IOVNzYLnp7LNYBjfSqpn2jJbBVI4uaXD5Shfk3ewrClTJLH1k6L7XZ4bHP6sQVuVE9WbnHG8OFcUPfJ4PmsvaO0037-PmdB2HhTaQobpwkNbHawS954xdz7iotGEu4tGEO85LnaqfvJHac3AL85-X1N2aoqz7UXTTjDcI3ADmk5Ak8cXw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" rel="nofollow"><span class="view-large-text">View Large</span></a><a class="download-ppt figure-table-link is-b stats-download-figure-table" path-from-xml="aoi230101f1" href="/downloadimage.aspx?image=https://cdn.jamanetwork.com/ama/content_public/journal/jama-health-forum/939314/aoi230101f1_1707259166.65766.png?Expires=1732031493&Signature=XQV7wJpJUQHyd3gEXeTq1gRw2QvbgGaYRBdFvgg~xCWctV3ZShgHGP5DJ4hOOt3uQf3Mosba91OIEriJLNlv3IQhnvqA8052aYGPZPPzlemCthtkJJYJJokBIWSPDV2Nd1OoqXfffuD7B7CtQMk9edKz6kO3FqylS6af3IOVNzYLnp7LNYBjfSqpn2jJbBVI4uaXD5Shfk3ewrClTJLH1k6L7XZ4bHP6sQVuVE9WbnHG8OFcUPfJ4PmsvaO0037-PmdB2HhTaQobpwkNbHawS954xdz7iotGEu4tGEO85LnaqfvJHac3AL85-X1N2aoqz7UXTTjDcI3ADmk5Ak8cXw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=249487563&ar=2815058&imagename=&siteId=193" rel="nofollow"><span class="download-ppt-text">Download</span></a><a class="figure-table-twitter figure-table-link figure-table-social addthis_button_twitter is-b" rel="nofollow"><span class="share-text"> </span></a><a class="figure-table-facebook figure-table-link figure-table-social addthis_button_facebook is-b" rel="nofollow"><span class="share-text"> </span></a>
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<a href="https://cdn.jamanetwork.com/ama/content_public/journal/jama-health-forum/939314/aoi230101f1_1707259166.65766.png?Expires=1732031493&Signature=XQV7wJpJUQHyd3gEXeTq1gRw2QvbgGaYRBdFvgg~xCWctV3ZShgHGP5DJ4hOOt3uQf3Mosba91OIEriJLNlv3IQhnvqA8052aYGPZPPzlemCthtkJJYJJokBIWSPDV2Nd1OoqXfffuD7B7CtQMk9edKz6kO3FqylS6af3IOVNzYLnp7LNYBjfSqpn2jJbBVI4uaXD5Shfk3ewrClTJLH1k6L7XZ4bHP6sQVuVE9WbnHG8OFcUPfJ4PmsvaO0037-PmdB2HhTaQobpwkNbHawS954xdz7iotGEu4tGEO85LnaqfvJHac3AL85-X1N2aoqz7UXTTjDcI3ADmk5Ak8cXw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" path-from-xml="aoi230101f1" rel="nofollow"><img data-original="https://cdn.jamanetwork.com/ama/content_public/journal/jama-health-forum/939314/m_aoi230101f1_1707259166.65766.png?Expires=1732031493&Signature=FN-QrxPUuvsdCGaNCApS27LbahN9rXBNu0IgN1xeIlcXfhcQJBXGEUGdKcdajEAvEnJdfew-VzDYHznPUDwOzp5m9Iz0Zg~3FyZBYow3G38YtS4Lh~b7jsZbzZ4m3zwdwb-5QC1RA~zcKyQAg~45FaljHZ~mAtpKJin3faJTT4I5AsRrMUHl~N3~HzNdKJdgY6G9YWTWFFgn23cYVTnNGH4btJNI5Z80yUPJ7FxXycV-n28dfj7eSvyV1dHf2sszSglIu-9GOjb9mf0o4IVonHaeCxZkp1m-C9Ghs7bhYMboi-OLUCUCl9cP8WLbdUE7G3GuqrbGYwzDxlZtBlmsaA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Adjusted Medicare Advantage (MA) Coverage, Postacute Care Use, and Patient Outcomes, 2015-2016" class="content-img lazy" path-from-xml="aoi230101f1"></a>
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<p class="para">When MA coverage (A) was more than 99% but less than 100%, we plotted 99% to ensure sample sizes greater than 12.</p>
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<div class="table-label">Table 1. Comparison of Characteristics of Hospitalized Retirees With Public Insurance, by Study Group, 2015 vs 2016</div><a class="figure-table-anchor" id="aoi230101t1"> </a>
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<a class="view-large figure-table-link is-b desktop-only" path-from-xml="aoi230101t1" href="https://cdn.jamanetwork.com/ama/content_public/journal/jama-health-forum/939314/aoi230101t1_1707259166.63265.png?Expires=1732031493&Signature=ujNVelJnYLhHt9mmSNPL0S1SxBEMBNkLNd8khOHa~aPz16OINsFv9jLvnDboGINQe~5GK7oaYZKJQJhuWhlEQuKy9vtVwP5aY83KlZmrDP~Z-E-gCdsRRKDlgYGhklYyPna6lgeDAfIfcnby9Zl6jAj7wEPrSJe3vrgJvmtNcY8-AknTmY~9uA4KaqVKfqpUwyDE2EnozohLf0fFT-NAvX1lZgo0QuULWvHTMHXbpjqdXff74lVBZdn8gijHNGO~jPiNO~swWFQU5GkSvvocggnU-hM~oo-fTD~iCd8YQwYLQCQyqqBFRNH0Fq7k53uYe5IrPqjgNvMAXBb~SvGADA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" rel="nofollow"><span class="view-large-text">View Large</span></a><a class="download-ppt figure-table-link is-b stats-download-figure-table" path-from-xml="aoi230101t1" href="/downloadimage.aspx?image=https://cdn.jamanetwork.com/ama/content_public/journal/jama-health-forum/939314/aoi230101t1_1707259166.63265.png?Expires=1732031493&Signature=ujNVelJnYLhHt9mmSNPL0S1SxBEMBNkLNd8khOHa~aPz16OINsFv9jLvnDboGINQe~5GK7oaYZKJQJhuWhlEQuKy9vtVwP5aY83KlZmrDP~Z-E-gCdsRRKDlgYGhklYyPna6lgeDAfIfcnby9Zl6jAj7wEPrSJe3vrgJvmtNcY8-AknTmY~9uA4KaqVKfqpUwyDE2EnozohLf0fFT-NAvX1lZgo0QuULWvHTMHXbpjqdXff74lVBZdn8gijHNGO~jPiNO~swWFQU5GkSvvocggnU-hM~oo-fTD~iCd8YQwYLQCQyqqBFRNH0Fq7k53uYe5IrPqjgNvMAXBb~SvGADA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=249487560&ar=2815058&imagename=&siteId=193" rel="nofollow"><span class="download-ppt-text">Download</span></a><a class="figure-table-twitter figure-table-link figure-table-social addthis_button_twitter is-b" rel="nofollow"><span class="share-text"> </span></a><a class="figure-table-facebook figure-table-link figure-table-social addthis_button_facebook is-b" rel="nofollow"><span class="share-text"> </span></a>
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<a href="https://cdn.jamanetwork.com/ama/content_public/journal/jama-health-forum/939314/aoi230101t1_1707259166.63265.png?Expires=1732031493&Signature=ujNVelJnYLhHt9mmSNPL0S1SxBEMBNkLNd8khOHa~aPz16OINsFv9jLvnDboGINQe~5GK7oaYZKJQJhuWhlEQuKy9vtVwP5aY83KlZmrDP~Z-E-gCdsRRKDlgYGhklYyPna6lgeDAfIfcnby9Zl6jAj7wEPrSJe3vrgJvmtNcY8-AknTmY~9uA4KaqVKfqpUwyDE2EnozohLf0fFT-NAvX1lZgo0QuULWvHTMHXbpjqdXff74lVBZdn8gijHNGO~jPiNO~swWFQU5GkSvvocggnU-hM~oo-fTD~iCd8YQwYLQCQyqqBFRNH0Fq7k53uYe5IrPqjgNvMAXBb~SvGADA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" path-from-xml="aoi230101t1" rel="nofollow"><img data-original="https://cdn.jamanetwork.com/ama/content_public/journal/jama-health-forum/939314/m_aoi230101t1_1707259166.63265.png?Expires=1732031493&Signature=U8NF701TvzsKtDEEbXq9r5bxQ52O5ojIWacQvFmnkQ7-vGoiBZ98SDpQSDkvxASyxHpTteHURUtV9VMcFwZxq8cWoGF0EiPOkyDZE-zm2oPY9ydc~EZ-Hx0D6-PHTOqqohzL3cWS47~ZC442iHyq6EB4RwOMprV0DZj-NxhMh9yEAE5M-i6aXXgPY5NVMMsIXFY6QO0o7Cf6rZnXKwQsR0f004a8uomim98uU5ocwO9Jc8OctBLyPq8UGJg7WPjAVCSZn3mjtrksVCT-mL-NihATjLoZiyHNCQK9fAPlheveYhSRC-KUvTk7~pFokvaWZwZbCR~6Rvjf0dO7cKu5jA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Comparison of Characteristics of Hospitalized Retirees With Public Insurance, by Study Group, 2015 vs 2016" class="content-img lazy" path-from-xml="aoi230101t1"></a>
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<div class="table-label">Table 2. Difference-in-Difference Estimates for Medicare Advantage (MA) Coverage and Postacute Care Use</div><a class="figure-table-anchor" id="aoi230101t2"> </a>
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<div class="supplement-title"><span class="title-label">Supplement 1.</span><p class="para">eAppendix</p><p class="para">eResults.</p></div>
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<div class="supplement-title"><span class="title-label">Supplement 2.</span><p class="para">Data Sharing Statement</p></div>
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<div class="references">
<div class="reference"><a class="reference-number" id="aoi230101r1">1.</a>
<div class="reference-content">Kaiser Family Foundation. Medicare Advantage in 2023: Enrollment Update and Key Trends. Accessed December 1, 2023.
<a href="https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2023-enrollment-update-and-key-trends/">https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2023-enrollment-update-and-key-trends/</a></div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r2">2.</a>
<div class="reference-content">Neuman P, Jacobson GA. Medicare Advantage checkup. <i xmlns:helper="urn:XsltStringHelper"> N Engl J Med</i>. 2018;379(22):2163-2172.
doi:<a href="http://dx.doi.org/10.1056/NEJMhpr1804089">10.1056/NEJMhpr1804089</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30428276" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Medicare%20Advantage%20checkup.&author=P%20Neuman&author=GA%20Jacobson&publication_year=2018&journal=N%20Engl%20J%20Med&volume=379&pages=2163-2172" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1056/NEJMhpr1804089" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r3">3.</a>
<div class="reference-content">Hong I, Goodwin JS, Reistetter TA, et al. Comparison of functional status improvements among patients with stroke receiving postacute care in inpatient
rehabilitation vs skilled nursing facilities. <i xmlns:helper="urn:XsltStringHelper"> JAMA Netw Open</i>. 2019;2(12):e1916646.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamanetworkopen.2019.16646">10.1001/jamanetworkopen.2019.16646</a><br><a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2756256" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/31800069" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Comparison%20of%20functional%20status%20improvements%20among%20patients%20with%20stroke%20receiving%20postacute%20care%20in%20inpatient%20rehabilitation%20vs%20skilled%20nursing%20facilities.&author=I%20Hong&author=JS%20Goodwin&author=TA%20Reistetter&publication_year=2019&journal=JAMA%20Netw%20Open&volume=2&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamanetworkopen.2019.16646" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r4">4.</a>
<div class="reference-content">Buntin MB, Colla CH, Deb P, Sood N, Escarce JJ. Medicare spending and outcomes after postacute care for stroke and hip fracture.
<i xmlns:helper="urn:XsltStringHelper"> Med Care</i>. 2010;48(9):776-784.
doi:<a href="http://dx.doi.org/10.1097/MLR.0b013e3181e359df">10.1097/MLR.0b013e3181e359df</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/20706167" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Medicare%20spending%20and%20outcomes%20after%20postacute%20care%20for%20stroke%20and%20hip%20fracture.&author=MB%20Buntin&author=CH%20Colla&author=P%20Deb&author=N%20Sood&author=JJ%20Escarce&publication_year=2010&journal=Med%20Care&volume=48&pages=776-784" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1097/MLR.0b013e3181e359df" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r5">5.</a>
<div class="reference-content">Werner RM, Coe NB, Qi M, Konetzka RT. Patient outcomes after hospital discharge to home with home health care vs to a skilled nursing facility.
<i xmlns:helper="urn:XsltStringHelper"> JAMA Intern Med</i>. 2019;179(5):617-623.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2018.7998">10.1001/jamainternmed.2018.7998</a><br><a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2727848" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30855652" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Patient%20outcomes%20after%20hospital%20discharge%20to%20home%20with%20home%20health%20care%20vs%20to%20a%20skilled%20nursing%20facility.&author=RM%20Werner&author=NB%20Coe&author=M%20Qi&author=RT%20Konetzka&publication_year=2019&journal=JAMA%20Intern%20Med&volume=179&pages=617-623" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamainternmed.2018.7998" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r6">6.</a>
<div class="reference-content">US Department of Health and Human Services Office of Inspector General. Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to
Medically Necessary Care. Accessed June 8, 2023. <a href="https://oig.hhs.gov/oei/reports/OEI-09-18-00260.asp">https://oig.hhs.gov/oei/reports/OEI-09-18-00260.asp</a></div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r7">7.</a>
<div class="reference-content">Skopec L, Huckfeldt PJ, Wissoker D, et al. Home health and postacute care use in Medicare Advantage and traditional Medicare.
<i xmlns:helper="urn:XsltStringHelper"> Health Aff (Millwood)</i>. 2020;39(5):837-842.
doi:<a href="http://dx.doi.org/10.1377/hlthaff.2019.00844">10.1377/hlthaff.2019.00844</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32364874" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Home%20health%20and%20postacute%20care%20use%20in%20Medicare%20Advantage%20and%20traditional%20Medicare.&author=L%20Skopec&author=PJ%20Huckfeldt&author=D%20Wissoker&publication_year=2020&journal=Health%20Aff%20%28Millwood%29&volume=39&pages=837-842" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1377/hlthaff.2019.00844" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r8">8.</a>
<div class="reference-content">Huckfeldt PJ, Escarce JJ, Rabideau B, Karaca-Mandic P, Sood N. Less intense postacute care, better outcomes for enrollees in Medicare Advantage than those
in fee-for-service. <i xmlns:helper="urn:XsltStringHelper"> Health Aff (Millwood)</i>. 2017;36(1):91-100.
doi:<a href="http://dx.doi.org/10.1377/hlthaff.2016.1027">10.1377/hlthaff.2016.1027</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/28069851" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Less%20intense%20postacute%20care%2C%20better%20outcomes%20for%20enrollees%20in%20Medicare%20Advantage%20than%20those%20in%20fee-for-service.&author=PJ%20Huckfeldt&author=JJ%20Escarce&author=B%20Rabideau&author=P%20Karaca-Mandic&author=N%20Sood&publication_year=2017&journal=Health%20Aff%20%28Millwood%29&volume=36&pages=91-100" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1377/hlthaff.2016.1027" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r9">9.</a>
<div class="reference-content">Newhouse JP, Price M, McWilliams JM, Hsu J, Souza J, Landon BE. Adjusted mortality rates are lower for Medicare Advantage than traditional Medicare,
but the rates converge over time. <i xmlns:helper="urn:XsltStringHelper"> Health Aff (Millwood)</i>. 2019;38(4):554-560.
doi:<a href="http://dx.doi.org/10.1377/hlthaff.2018.05390">10.1377/hlthaff.2018.05390</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30933606" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Adjusted%20mortality%20rates%20are%20lower%20for%20Medicare%20Advantage%20than%20traditional%20Medicare%2C%20but%20the%20rates%20converge%20over%20time.&author=JP%20Newhouse&author=M%20Price&author=JM%20McWilliams&author=J%20Hsu&author=J%20Souza&author=BE%20Landon&publication_year=2019&journal=Health%20Aff%20%28Millwood%29&volume=38&pages=554-560" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1377/hlthaff.2018.05390" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r10">10.</a>
<div class="reference-content">Ohio Public Retirees Retirement System. 2015 OPERS HealthCare Medicare Guide. 2014. <a href="https://www.opers.org/">https://www.opers.org/</a></div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r11">11.</a>
<div class="reference-content">Cooper KB, Mears SC, Siegel ER, Stambough JB, Bumpass DB, Cherney SM. The hip and femur fracture bundle: preliminary findings from a tertiary
hospital. <i xmlns:helper="urn:XsltStringHelper"> J Arthroplasty</i>. 2022;37(8S):S761-S765.
doi:<a href="http://dx.doi.org/10.1016/j.arth.2022.03.059">10.1016/j.arth.2022.03.059</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/35314286" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20hip%20and%20femur%20fracture%20bundle%3A%20preliminary%20findings%20from%20a%20tertiary%20hospital.&author=KB%20Cooper&author=SC%20Mears&author=ER%20Siegel&author=JB%20Stambough&author=DB%20Bumpass&author=SM%20Cherney&publication_year=2022&journal=J%20Arthroplasty&volume=37&pages=S761-S765" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.arth.2022.03.059" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r12">12.</a>
<div class="reference-content">US Health and Human Services. CMS Comprehensive Joint Replacement program.
<a href="https://www.hhs.gov/guidance/document/cjr-icd-9-and-icd-10-hip-fracture-diagnosis-codes">https://www.hhs.gov/guidance/document/cjr-icd-9-and-icd-10-hip-fracture-diagnosis-codes</a> </div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r13">13.</a>
<div class="reference-content">Medicare Payment Advisory Commission. Inpatient Rehabilitation Facilities Payment System. Published 2021. Accessed July 27, 2023.
<a href="https://www.medpac.gov/wp-content/uploads/2021/11/medpac_payment_basics_21_irf_final_sec.pdf">https://www.medpac.gov/wp-content/uploads/2021/11/medpac_payment_basics_21_irf_final_sec.pdf</a></div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r14">14.</a>
<div class="reference-content">Ohio Public Retirees Retirement System. Open Enrollment Guide 2016. Published 2015. Accessed December 1, 2023.
<a href="https://www.opers.org/pubs-archive/healthcare/open/2016/2016openenrollmentguide.pdf">https://www.opers.org/pubs-archive/healthcare/open/2016/2016openenrollmentguide.pdf</a></div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r15">15.</a>
<div class="reference-content">US Centers for Medicare & Medicaid Services. Capturing days on which Medicare beneficiaries are entitled to Medicare Advantage (MA) in the Medicare/Supplemental Security Income (SSI) fraction.
Published 2007. Accessed July 27, 2023.
<a href="https://www.hhs.gov/guidance/document/capturing-days-which-medicare-beneficiaries-are-entitled-medicare-advantage-ma">https://www.hhs.gov/guidance/document/capturing-days-which-medicare-beneficiaries-are-entitled-medicare-advantage-ma</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r16">16.</a>
<div class="reference-content">ResDAC. Identifying Medicare Managed Care Beneficiaries from the Master Beneficiary Summary or Denominator Files. Published 2021. Accessed July 28, 2023.
<a href="https://resdac.org/articles/identifying-medicare-managed-care-beneficiaries-master-beneficiary-summary-or-denominator">https://resdac.org/articles/identifying-medicare-managed-care-beneficiaries-master-beneficiary-summary-or-denominator</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r17">17.</a>
<div class="reference-content">US Centers for Medicare & Medicaid Services. Home Health Quality Reporting Program. Published 2023. Accessed November 30, 2023.
<a href="https://www.cms.gov/medicare/quality/home-health">https://www.cms.gov/medicare/quality/home-health</a></div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r18">18.</a>
<div class="reference-content">Geruso M, Layton T. Upcoding: evidence from Medicare on Squishy risk adjustment. <i xmlns:helper="urn:XsltStringHelper"> J Polit Econ</i>. 2020;12(3):984-1026.
doi:<a href="http://dx.doi.org/10.1086/704756">10.1086/704756</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32719571" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Upcoding%3A%20evidence%20from%20Medicare%20on%20Squishy%20risk%20adjustment.&author=M%20Geruso&author=T%20Layton&publication_year=2020&journal=J%20Polit%20Econ&volume=12&pages=984-1026" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1086/704756" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r19">19.</a>
<div class="reference-content">US National Cancer Institute. Health Service Areas. Published 2008. Accessed December 1, 2023.
<a href="https://seer.cancer.gov/seerstat/variables/countyattribs/hsa.html">https://seer.cancer.gov/seerstat/variables/countyattribs/hsa.html</a></div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r20">20.</a>
<div class="reference-content">US Department of Agriculture Economic Research Service. Rural-Urban Continuum Codes. Published 2023. Accessed November 30, 2023.
<a href="https://www.ers.usda.gov/data-products/rural-urban-continuum-codes/">https://www.ers.usda.gov/data-products/rural-urban-continuum-codes/</a></div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r21">21.</a>
<div class="reference-content">Cupp MA, Beaudoin FL, Hayes KN, et al. Post-acute care setting after hip fracture hospitalization and subsequent opioid use in older adults.
<i xmlns:helper="urn:XsltStringHelper"> J Am Med Dir Assoc</i>. 2023;24(7):971-977.e4.
doi:<a href="http://dx.doi.org/10.1016/j.jamda.2023.03.012">10.1016/j.jamda.2023.03.012</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/37080246" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Post-acute%20care%20setting%20after%20hip%20fracture%20hospitalization%20and%20subsequent%20opioid%20use%20in%20older%20adults.&author=MA%20Cupp&author=FL%20Beaudoin&author=KN%20Hayes&publication_year=2023&journal=J%20Am%20Med%20Dir%20Assoc&volume=24&pages=971-977.e4" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jamda.2023.03.012" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r22">22.</a>
<div class="reference-content">Achola EM, Stevenson DG, Keohane LM. Postacute care services use and outcomes among traditional Medicare and Medicare Advantage beneficiaries.
<i xmlns:helper="urn:XsltStringHelper"> JAMA Health Forum</i>. 2023;4(8):e232517.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamahealthforum.2023.2517">10.1001/jamahealthforum.2023.2517</a><br><a href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2808465" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/37594745" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Postacute%20care%20services%20use%20and%20outcomes%20among%20traditional%20Medicare%20and%20Medicare%20Advantage%20beneficiaries.&author=EM%20Achola&author=DG%20Stevenson&author=LM%20Keohane&publication_year=2023&journal=JAMA%20Health%20Forum&volume=4&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamahealthforum.2023.2517" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r23">23.</a>
<div class="reference-content">Kumar A, Rahman M, Trivedi AN, Resnik L, Gozalo P, Mor V. Comparing post-acute rehabilitation use, length of stay, and outcomes experienced by
Medicare fee-for-service and Medicare Advantage beneficiaries with hip fracture in the United States: a secondary analysis of administrative data. <i xmlns:helper="urn:XsltStringHelper"> PLoS Med</i>.
2018;15(6):e1002592.
doi:<a href="http://dx.doi.org/10.1371/journal.pmed.1002592">10.1371/journal.pmed.1002592</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/29944655" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Comparing%20post-acute%20rehabilitation%20use%2C%20length%20of%20stay%2C%20and%20outcomes%20experienced%20by%20Medicare%20fee-for-service%20and%20Medicare%20Advantage%20beneficiaries%20with%20hip%20fracture%20in%20the%20United%20States%3A%20a%20secondary%20analysis%20of%20administrative%20data.&author=A%20Kumar&author=M%20Rahman&author=AN%20Trivedi&author=L%20Resnik&author=P%20Gozalo&author=V%20Mor&publication_year=2018&journal=PLoS%20Med&volume=15&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1371/journal.pmed.1002592" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r24">24.</a>
<div class="reference-content">Loomer L, Kosar CM, Meyers DJ, Thomas KS. Comparing receipt of prescribed post-acute home health care between Medicare Advantage and traditional Medicare
beneficiaries: an observational study. <i xmlns:helper="urn:XsltStringHelper"> J Gen Intern Med</i>. 2021;36(8):2323-2331.
doi:<a href="http://dx.doi.org/10.1007/s11606-020-06282-3">10.1007/s11606-020-06282-3</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33051838" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Comparing%20receipt%20of%20prescribed%20post-acute%20home%20health%20care%20between%20Medicare%20Advantage%20and%20traditional%20Medicare%20beneficiaries%3A%20an%20observational%20study.&author=L%20Loomer&author=CM%20Kosar&author=DJ%20Meyers&author=KS%20Thomas&publication_year=2021&journal=J%20Gen%20Intern%20Med&volume=36&pages=2323-2331" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1007/s11606-020-06282-3" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r25">25.</a>
<div class="reference-content">Barnett ML, Mehrotra A, Grabowski DC. Postacute care: the piggy bank for savings in alternative payment models?
<i xmlns:helper="urn:XsltStringHelper"> N Engl J Med</i>. 2019;381(4):302-303.
doi:<a href="http://dx.doi.org/10.1056/NEJMp1901896">10.1056/NEJMp1901896</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/31340092" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Postacute%20care%3A%20the%20piggy%20bank%20for%20savings%20in%20alternative%20payment%20models%3F&author=ML%20Barnett&author=A%20Mehrotra&author=DC%20Grabowski&publication_year=2019&journal=N%20Engl%20J%20Med&volume=381&pages=302-303" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1056/NEJMp1901896" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
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<div class="comment-item--date-submitted">February 27, 2024</div>
<div class="comment-item--title thm-col fw-b sb-pc">Medicare Advantage restricts patient care, while costing us more</div>
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<span class="author-name fw-b">Linda Burke, Ph.D.</span> | Elmhurst University
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<span class="comment-item--text-limited ellipsis">The authors appropriately refrain from claiming equal outcomes for MA and TM patients in postacute care, based only 30 days of follow-up post-hospitalization. They appropriately
note that other studies have found better outcomes following the inpatient rehabilitation facility (IRF) that is more available to TM patients, versus its near-inaccessibility to patients in MA. <br>
<br> However, the article is based on an implied premise that is just not true: that by withholding more care from more patients, MA is saving taxpayer dollars. In fact, MA is 6 percent more expensive per patient than TM. This
is because MA is not</span>
<span class="comment-item--text-remaining"> Medicare, but a private, for-profit insurance plan. Profits are made by restricting care, limited networks, and overcoding. Other reasons for the higher cost of MA, versus TM, are the
payment upfront to the insurance company for each new MA enrollee; and also the twice-as-high commission paid to insurance brokers for selling a MA plan, versus a TM plan. (1)<br>
<br> Any discussion of outcomes under TM versus MA is incomplete without acknowledging that MA is costing us more than TM, while seriously restricting patients' access to care.<br>
<br> (1) J. Jacobson and D. Blumenthal. The Predominance of Medicare Advantage. N Engl J Med 2023; 389:2291-2298 (December 14, 2023)</span>
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<h1 class="meta-article-title ">Postacute Care for Medicare Advantage Enrollees Who Switched to Traditional Medicare Compared With Those Who Remained in Medicare Advantage</h1>
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</span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Victoria+Shier&q=Victoria+Shier" rel="nofollow" target="_blank">Victoria Shier, PhD<sup>2,7</sup></a></span><span class="al-author-delim">;
</span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Jos%c3%a9+J.+Escarce&q=Jos%c3%a9+J.+Escarce" rel="nofollow" target="_blank">José J. Escarce, MD, PhD<sup>3,4</sup></a></span>;
<a class="meta-authors--etal td-u stats-meta-authors--etal">et al</a></span>
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class="wi-fullname brand-fg"><a href="/searchresults?author=Brendan+Rabideau&q=Brendan+Rabideau" rel="nofollow" target="_blank">Brendan Rabideau, PhD<sup>5,6</sup></a></span><span class="al-author-delim">;
</span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Tyler+Boese&q=Tyler+Boese" rel="nofollow" target="_blank">Tyler Boese, MS<sup>1</sup></a></span><span class="al-author-delim">; </span><span
class="wi-fullname brand-fg"><a href="/searchresults?author=Helen+M.+Parsons&q=Helen+M.+Parsons" rel="nofollow" target="_blank">Helen M. Parsons, PhD<sup>1</sup></a></span><span class="al-author-delim">; </span><span
class="wi-fullname brand-fg"><a href="/searchresults?author=Neeraj+Sood&q=Neeraj+Sood" rel="nofollow" target="_blank">Neeraj Sood, PhD<sup>2,7</sup></a></span></span>
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<div class="meta-author-name"><sup>1</sup>Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis</div>
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<div class="meta-author-name"><sup>2</sup>Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles</div>
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<div class="meta-author-name"><sup>3</sup>Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles</div>
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<div class="meta-author-name"><sup>4</sup>Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles</div>
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<div class="meta-author-name"><sup>5</sup>Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland</div>
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<div class="meta-author-name"><sup>6</sup>Analysis Group, Inc, Los Angeles, California</div>
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<div class="meta-author-name"><sup>7</sup>Department of Health Policy and Management, Sol Price School of Public Policy, University of Southern California, Los Angeles</div>
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<span class="meta-citation-journal-name">JAMA Health Forum. </span><span class="meta-citation"> 2024;5(2):e235325. doi:10.1001/jamahealthforum.2023.5325</span>
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<span class="heading-text thm-col h3 cb section-type-keyPoints decorated-hed sb-sc ">Key Points</span>
<p><strong>Question</strong> <span>What is the association of Medicare Advantage (MA) enrollment with postacute care use and patient outcomes among retired state employees?</span></p>
<p><strong>Findings</strong> <span>This cohort study using Medicare data including 4613 hospitalizations of retired Ohio state employees found that after a mandatory MA plan was discontinued, enrollees who switched to
traditional Medicare received more intensive postacute care. No changes in 30-day hospital readmissions or mortality were observed.</span></p>
<p><strong>Meaning</strong> <span>This finding suggests that MA plans provided less intensive postacute care than traditional Medicare, with no significant difference in measured short-term outcomes; measures of postacute
functional status over a longer follow-up period are needed.</span></p> <a class="article-section-id-anchor" id="249487531"></a>
<div class="h3 cb section-type-abstract decorated-hed ">
<div class="heading-text thm-col sb-sc"> Abstract </div>
</div>
<p><strong>Importance</strong> <span>Medicare Advantage (MA) plans receive capitated per enrollee payments that create financial incentives to provide care more efficiently than traditional Medicare (TM); however, incentives
could be associated with MA plans reducing use of beneficial services. Postacute care can improve functional status, but it is costly, and thus may be provided differently to Medicare beneficiaries by MA plans compared with
TM.</span></p>
<p><strong>Objective</strong> <span>To estimate the association of MA compared with TM enrollment with postacute care use and postdischarge outcomes.</span></p>
<p><strong>Design, Setting, and Participants</strong> <span>This was a cohort study using Medicare data on 4613 hospitalizations among retired Ohio state employees and 2 comparison groups in 2015 and 2016. The study investigated
the association of a policy change with use of postacute care and outcomes. The policy changed state retiree health benefits in Ohio from a mandatory MA plan to subsidies for either supplemental TM coverage or an MA plan. After
policy implementation, approximately 75% of retired Ohio state employees switched to TM. Hospitalizations for 3 high-volume conditions that usually require postacute rehabilitation were assessed. Data from the Medicare Provider
Analysis and Review files were used to identify all hospitalizations in short-term acute care hospitals. Difference-in-difference regressions were used to estimate changes for retired Ohio state employees compared with other 2015
MA enrollees in Ohio and with Kentucky public retirees who were continuously offered a mandatory MA plan. Data analyses were performed from September 1, 2019, to November 30, 2023.</span></p>
<p><strong>Exposures</strong> <span>Enrollment in Ohio state retiree health benefits in 2015, after which most members shifted to TM.</span></p>
<p><strong>Main Outcomes and Measures</strong> <span>Received care in an inpatient rehabilitation facility, skilled nursing facility, or home health, or any postacute care; the occurrence of any hospital readmission; the number
of days in the community during the 30 days after hospital discharge; and mortality.</span></p>
<p><strong>Results</strong> <span>The study sample included 2373 hospitalizations for Ohio public retirees, 1651 hospitalizations for other Humana MA enrollees in Ohio, and 589 hospitalizations for public retirees in Kentucky.
After the 2016 policy implementation, the percentage of hospitalizations covered by MA decreased by 70.1 (95% CI, −74.2 to −65.9) percentage points (pp), inpatient rehabilitation facility admissions increased by 9.7 (95% CI, 4.7
to 14.7) pp, use of only home health or skilled nursing facility care fell by 8.6 (95% CI, −14.6 to −2.6) pp, and days in the community fell by 1.6 (95% CI, −2.9 to −0.3) days for Ohio public retirees compared with other Humana MA
enrollees in Ohio. There was no change in 30-day mortality or hospital readmissions; similar results were found by comparisons using Kentucky public retirees as a control group.</span></p>
<p><strong>Conclusions and Relevance</strong> <span>The findings of this cohort study indicate that after a change in retiree health benefits, most Ohio public retirees shifted from MA to TM and received more intensive postacute
care with no significant change in measured short-term postdischarge outcomes. Future work should consider additional measures of postacute functional status over a longer follow-up period.</span></p>
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<a class="article-section-id-anchor" id="249487536"></a>
<div class="h3 cb section-type-section ">
<div class="heading-text thm-col sb-sc"> Introduction </div>
</div>
<a class="article-section-id-anchor" id="249487537"></a>
<p class="para">The share of Medicare beneficiaries enrolled in Medicare Advantage (MA) instead of traditional fee-for-service Medicare (TM) continues to grow, with the MA share increasing from 19% in 2007 to 51% in
2023.<sup><a href="#aoi230101r1" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">1</a></sup> The US Centers for Medicare & Medicaid Services (CMS) pay MA plans a monthly capitated rate to cover nearly
all health care expenses for plan enrollees, and plans keep as profits the portion of the payment not used for enrollees’ health care expenses. Plans are permitted to use tools such as prior authorization and a limited provider
network to manage enrollees’ health care use.<sup><a href="#aoi230101r2" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">2</a></sup> Proponents argue that these financial incentives and delivery tools for MA
plans enable them to provide care more efficiently than TM. However, in reducing costs, MA plans may focus on maintaining short-term health outcomes while neglecting services that promote better long-term health and functioning.</p>
<a class="article-section-id-anchor" id="249487538"></a>
<p class="para">Postacute care (PAC) may contribute to better long-term functioning, but also imposes higher short-term costs, and thus may be provided differently by MA plans compared with TM. After a hospital stay, patients can
receive rehabilitation services and skilled nursing care in an inpatient rehabilitation facility (IRF), a skilled nursing facility (SNF), or in their home from a home health agency (HH). Although there have not been large randomized
clinical trials evaluating alternative settings for postacute rehabilitation services, observational research has found that patients admitted to IRFs after a hospitalization for stroke had better mobility and ability to perform
self-care compared with patients admitted to SNFs.<sup><a href="#aoi230101r3" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">3</a></sup> Other research found that patients admitted to IRFs had lower
mortality (after stroke hospitalizations) and increased longer-term community residence (after hip fracture and stroke hospitalizations) compared with patients discharged to
SNFs.<sup><a href="#aoi230101r4" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">4</a></sup> Similarly, patients admitted to SNFs had lower readmissions than patients receiving HH, although with no
difference in mortality or functional outcomes.<sup><a href="#aoi230101r5" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">5</a></sup> However, IRF stays are substantially more expensive than SNF stays,
which in turn are more expensive than HH
episodes.<sup><a href="#aoi230101r5" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">5</a></sup><sup>,<a href="#aoi230101r6" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">6</a></sup>
</p> <a class="article-section-id-anchor" id="249487539"></a>
<p class="para">A 2022 report from the US Department of Health and Human Services Office of the Inspector General found that MA plans had denied requests for IRF care that were deemed to meet criteria for medical
necessity.<sup><a href="#aoi230101r6" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">6</a></sup> Consistent with the report, prior cross-sectional research has found that MA enrollees were more likely than
TM enrollees to be discharged to home without institutional postacute or HH after hospitalizations for joint replacement, stroke, and heart
failure,<sup><a href="#aoi230101r7" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">7</a></sup> and were less likely than TM enrollees to be admitted to IRFs across
conditions.<sup><a href="#aoi230101r7" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">7</a></sup><sup>,<a href="#aoi230101r8" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">8</a></sup>
The prior cross-sectional studies found limited evidence of an adverse association between MA enrollment and postdischarge outcomes such as readmissions. However, MA enrollment is voluntary and MA enrollees tend to be healthier (ie,
have lower mortality risk) than TM enrollees conditional on age, sex, and Medicaid enrollment.<sup><a href="#aoi230101r9" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">9</a></sup> As a result, studies
relating observed MA enrollment with patient outcomes may overstate MA’s ability to reduce costs without harming patient health. This study builds on prior work using changes in state retiree health benefits in Ohio as a natural
experiment to estimate the association of MA enrollment with PAC use and postdischarge outcomes.</p> <a class="article-section-id-anchor" id="249487540"></a>
<div class="h3 cb section-type-section ">
<div class="heading-text thm-col sb-sc"> Methods </div>
</div>
<a class="article-section-id-anchor" id="249487541"></a>
<p class="para">This study was reviewed and approved by the University of Minnesota Institutional Review Board. Informed consent was waived because the research involved minimal risk to participants. The study followed the
Strengthening the Reporting of Observational Studies in Epidemiology (<a href="http://www.equator-network.org/reporting-guidelines/strobe/">STROBE</a>) reporting guideline.</p>
<a class="article-section-id-anchor" id="249487542"></a>
<p class="para">We investigated changes in PAC use and postdischarge outcomes among retired Ohio state employees (hereafter, public retirees) whose retiree health benefits changed from a mandatory sponsored MA plan for public retirees
in 2015 to a subsidy for purchasing coverage through an MA plan or supplemental coverage for TM in 2016. In a 2015 benefits guide, the Ohio Public Employee Retirement System (OPERS) explained the change by noting that the
OPERS-sponsored MA plan was more costly than the more comprehensive supplemental Medigap plans on the individual market and that per-retiree costs of providing the OPERS group plan were
rising.<sup><a href="#aoi230101r10" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">10</a></sup> Under the new OPERS retiree health benefit, public retirees received a monthly Health Reimbursement Account
allowance of up to $337 that they could use to purchase Medigap, Part D, or MA coverage through a private Medicare exchange (the Medicare Connector) managed by a private contractor. In January 2015, all Medicare-eligible Ohio public
retirees receiving health benefits were enrolled in a mandatory group MA plan managed by Humana, Inc (hereafter, other Humana MA enrollees). In 2016, when public retirees had a choice of supplemental TM or MA plans, only 25% chose
to remain enrolled in MA (eResults in <a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-AOI230101-1">Supplement 1</a>). The OPERS benefits guide describing the comprehensive benefits of
supplemental TM Medigap plans may have persuaded some public retirees to switch to TM.</p> <a class="article-section-id-anchor" id="249487543"></a>
<p class="para">We estimated intent-to-treat effects of this policy change using a difference-in-differences approach, comparing changes in outcomes for Ohio public retirees after the change in health benefits with comparison groups
that were unaffected by the change. We focused on 2 distinct comparison groups that were likely to provide an accurate counterfactual for what would have happened to public retirees in the absence of the changes in health benefits.
Comparison group 1 comprised Ohio enrollees in other Humana MA plans (ie, not the plan for Ohio public retirees) in January 2015, 98% of whom remained enrolled in MA in 2016 as well. Because public retirees may have different trends
in health care use than other Medicare beneficiaries, for comparison group 2 we chose public retirees in Kentucky because they received retiree health benefits through a mandatory Humana MA plan in 2015 and 2016. Given that 75% of
the treatment group in Ohio shifted from MA to TM, whereas no more than 2% of the comparison groups shifted from MA to TM, our intention-to-treat estimates may provide a conservative estimate of the association of MA enrollment with
the stated study outcomes.</p> <a class="article-section-id-anchor" id="249487544"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Study Population </div>
</div>
<a class="article-section-id-anchor" id="249487545"></a>
<p class="para">Our analysis investigated hospital stays and 30-day postdischarge periods for the treatment group and the 2 comparison groups between 2015 and 2016. We focused on 3 high-volume conditions that require intensive
rehabilitation after hospitalization: lower extremity joint replacement after a fracture; hip and femur procedures (after a fracture; in an academic tertiary hospital, the most common procedures were intramedullary nailing, dynamic
hip screw, and open reduction internal fixation<sup><a href="#aoi230101r11" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">11</a></sup>); and stroke (only the first stroke observed per patient during the
study period). For joint replacement, we included MS-DRG codes 469 and 470, with a principal diagnosis of fracture per the <i>International Classification of Diseases, Ninth Revision (ICD-9) and 10 Revision (ICD-10)</i> that are
used by the CMS Comprehensive Joint Replacement program<sup><a href="#aoi230101r12" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">12</a></sup>; and for stroke, we included MS-DRG codes 64, 65, and 66.
Medicare stipulates that 60% of IRF admissions must meet a set of conditions determined to require intensive rehabilitation; hip fracture and stroke are both
included.<sup><a href="#aoi230101r13" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">13</a></sup> Notably, these hospitalizations are unlikely to be elective and are not readily predictable as they occur
after an acute event such as a fracture or a stroke. Therefore, it is unlikely that MA compared with TM enrollment will substantially affect the probability of hospitalization for these conditions, although we also investigated this
empirically. We excluded hospital discharges occurring in December 2016 because we were not able to observe PAC use in 2017. Our analysis focused on index hospitalizations—admissions that did not occur within 30 days of another
hospital discharge—and excluded hospitalizations during which the patient died.</p> <a class="article-section-id-anchor" id="249487546"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Data Sources </div>
</div>
<a class="article-section-id-anchor" id="249487547"></a>
<p class="para">We used the Medicare Master Beneficiary Summary File to identify retirees in Ohio with an MA plan or TM coverage, MA plan type and contract identifiers (for MA enrollees), state of residence, demographic and
socioeconomic status information, and mortality. We identified the contract identifiers for public retirees using information from the Ohio Public Retirees Open Enrollment Guide for retired state employees, detailed in the eAppendix
in
<a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-AOI230101-1">Supplement 1</a>.<sup><a href="#aoi230101r10" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">10</a></sup><sup>,<a href="#aoi230101r14" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">14</a></sup>
</p> <a class="article-section-id-anchor" id="249487548"></a>
<p class="para">A challenge to comparing health care use between MA and TM enrollees is finding consistent data for both types of Medicare beneficiaries. We identified index hospitalizations using the Medicare Provider Analysis and
Review (MedPAR) files, focusing on hospitals that received disproportionate share or medical education payments from CMS that are required to submit encounter claims for MA enrollees to receive full
payment<sup><a href="#aoi230101r15" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">15</a></sup><sup>,<a href="#aoi230101r16" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">16</a></sup>;
notably, this includes most short-term acute care hospitals.<sup><a href="#aoi230101r7" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">7</a></sup> We identified hospital discharges for the included
conditions based on the Medicare Severity Diagnosis-Related Group (MS-DRG) on the hospital claim.<sup><a href="#aoi230101r12" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">12</a></sup></p>
<a class="article-section-id-anchor" id="249487549"></a>
<p class="para">We identified SNF admissions and days using SNF claims for TM enrollees and the Minimum Data Set (MDS) assessments for MA enrollees (augmented with SNF claims, in the small number of cases where they were reported in
MedPAR). We identified IRF stays from the Inpatient Rehabilitation Facility Patient Assessment Instrument, and HH episodes from the Home Health Outcome and Assessment Information Set (OASIS) data given that facilities must submit
assessments for both MA and TM enrollees.<sup><a href="#aoi230101r17" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">17</a></sup></p> <a class="article-section-id-anchor" id="249487550"></a>
<p class="para">For our primary approach for measuring hospital readmissions, we used MedPAR and identified all hospitalizations in short-term acute care hospitals (across conditions) occurring within 30 days of the index hospital
discharge for which hospitals are required to submit information-only claims for MA enrollees. We created an alternative measure of readmissions, augmenting the MedPAR hospitalization data with discharge-level data from the
Healthcare Effectiveness Data and Information Set (HEDIS), which is further described in the eAppendix in
<a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-AOI230101-1">Supplement 1</a>.</p> <a class="article-section-id-anchor" id="249487551"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Study Measures </div>
</div>
<a class="article-section-id-anchor" id="249487552"></a>
<p class="para">The outcome variables for the study analyses included measures of PAC use and patient outcomes within 30-days of hospital discharge. We focused on 3 binary categories indicating level of PAC use: patient received any
IRF, with or without SNF and/or HH (category 1); SNF or HH, but no IRF (category 2); and no PAC, ie, no HH, SNF, or IRF (category 3). For category 2, we separately assessed whether the patient had received SNF (with or without HH)
compared with receiving only HH. Patient outcome variables included whether patients were readmitted to a hospital for any condition within 30 days of discharge (constructed separately using solely MedPAR data, and using both MedPAR
and HEDIS data); the number of days in the community during the 30-day postdischarge period (ie, alive and not in a hospital, nursing home, or institutional PAC setting); the number of days in an SNF, IRF, or nursing home; the
number of days in a hospital; and whether death occurred during the 30 days postdischarge; and days deceased.</p> <a class="article-section-id-anchor" id="249487553"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Statistical Analyses </div>
</div>
<a class="article-section-id-anchor" id="249487554"></a>
<p class="para">Difference-in-differences regressions were used to estimate changes in PAC use and postdischarge outcomes after hospitalizations before and after the benefits policy change compared with each of the 2 comparison
groups. Explanatory variables in the regression included the interaction effect of being an Ohio public retiree after the policy change in 2016 (giving the coefficient estimate of interest), an indicator variable for being an Ohio
public retiree, year by quarter fixed effects, hospital fixed effects, and control variables, including age, sex, RTI (Research Triangle Institute) race and ethnicity code, MS-DRG code (ie, reason for a hospital admission), Medicaid
eligibility, and fixed effects for the discharging hospital. We did not control for other comorbidities because of concerns about more intensive diagnosis coding in
MA.<sup><a href="#aoi230101r18" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">18</a></sup> We estimated separate models for each of the 2 comparison groups. Linear regressions were used for continuous
variables and linear probability models were used for binary outcomes. Clustered standard errors were calculated at the treatment status by health service area
level.<sup><a href="#aoi230101r19" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">19</a></sup> Further details on the statistical analysis are available in the eAppendix in
<a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-AOI230101-1">Supplement 1</a>.</p> <a class="article-section-id-anchor" id="249487555"></a>
<p class="para">In preliminary analyses, we estimated difference-in-differences regressions at the person-quarter level to assess whether the policy shifting Ohio public retirees to TM changed the probability of having hospital
admissions for the 3 conditions in our defined cohort. We performed this initial analysis because inclusion in our main analyses required having a hospitalization for a set of conditions, which could introduce selection bias if MA
enrollment affects the probability of hospital admission for these conditions.</p> <a class="article-section-id-anchor" id="249487556"></a>
<p class="para">The eAppendix in <a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-AOI230101-1">Supplement 1</a> describes event study regressions that allowed for testing for differences
in time trends in outcomes by treatment status before the policy implementation and assess dynamic estimated effects on outcomes postpolicy intervention. Intent-to-treat estimates included Ohio public retirees who shifted to TM but
also a minority number of individuals who continued to be enrolled in MA. To understand the broader generalizability of these estimates, we compared the characteristics of the 2 groups of Ohio public retirees (those who in 2016
switched from mandatory MA plan to other MA plans vs those who switched to TM instead). As a placebo test, we estimated separate difference-in-difference regressions for Ohio public retirees who continued with the MA plan (vs those
who switched to TM). In addition, we explored the presence of heterogeneous effects, estimating separate effects for patients with stroke or fracture, and for patients residing in metropolitan or nonmetropolitan
counties.<sup><a href="#aoi230101r20" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">20</a></sup></p> <a class="article-section-id-anchor" id="249487557"></a>
<p class="para">Statistical tests were 2-tailed and <i>P</i> < .05 were considered statistically significant. Data analyses were performed from September 1, 2019, to November 30, 2023, and final estimates were generated using
Stata, version 18.0 MP-parallel edition (StataCorp).</p> <a class="article-section-id-anchor" id="249487558"></a>
<div class="h3 cb section-type-section ">
<div class="heading-text thm-col sb-sc"> Results </div>
</div>
<a class="article-section-id-anchor" id="249487559"></a>
<p class="para">From January 1 to December 31, 2015, and from January 1 to November 1, 2016, there were 1217 and 1156 hospital discharges, respectively, for the 3 conditions (lower extremity joint replacement after a fracture, hip and
femur procedures, and stroke) among Ohio public retirees compared with 840 and 811 for other Ohio Humana MA enrollees, and 285 and 304 for Kentucky public retirees
(<a href="#aoi230101t1" class="table-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table 1</a>). The demographic characteristics of the Ohio public retirees in 2015 were similar to those of the comparison groups;
eg, both Ohio and Kentucky, public retirees were more likely to be female. However, in Kentucky, a higher percentage of public retirees were White. The composition of hospitalized individuals did not change substantially among
groups across the 2 years. Notably, we found no relative change in the probability of hospitalization for the conditions in the study sample for Ohio public retirees and either of the comparison groups (other Ohio Humana MA
enrollees or Kentucky retirees), alleviating concerns about selection bias coming from conditioning the main analysis on having a hospitalization (eResults in
<a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-AOI230101-1">Supplement 1</a>).</p> <a class="article-section-id-anchor" id="249487561"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Descriptive Findings </div>
</div>
<a class="article-section-id-anchor" id="249487562"></a>
<p class="para">The adjusted rate of MA coverage for hospital stays (adjusting for the control variables) decreased for Ohio public retirees hospitalized for the 3 conditions, from nearly 100% in early 2015 to approximately 25% in
2016, whereas enrollees in other Ohio Humana MA plans in 2015 (comparison group 1) mostly continued their enrollment in MA in 2016
(<a href="#aoi230101f1" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Figure</a>, A). When Ohio public retirees’ health benefits were provided through a mandatory Humana MA plan in 2015, inpatient
rehabilitation use was similar to other Ohio Humana MA plans (<8% of discharges), but when most Ohio public retirees switched to TM in 2016, inpatient rehabilitation admissions increased to approximately 16% of hospital
discharges, whereas other Ohio Humana MA plans’ IRF admission rates remained lower (<a href="#aoi230101f1" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Figure</a>, B).</p>
<a class="article-section-id-anchor" id="249487564"></a>
<p class="para">The percentage of Ohio public retirees and other Ohio Humana MA enrollees receiving only HH or SNF was greater than 75% in 2015, but fell for Ohio public retirees in 2016
(<a href="#aoi230101f1" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Figure</a>, C); the overall high rate of SNF admissions reflects that approximately half of the sample was comprised of patients
with hip fracture , a condition that has a high rate of discharge to SNFs after hospitalization.<sup><a href="#aoi230101r21" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">21</a></sup></p>
<a class="article-section-id-anchor" id="249487565"></a>
<p class="para">Hospital readmissions were similar for Ohio public retirees and other Humana MA enrollees in both 2015 and 2016, suggesting that switching from MA to TM did not affect hospital readmissions
(<a href="#aoi230101f1" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Figure</a>, D). However, there was a decrease in the number of days Ohio public retirees spent in the community after hospital
discharge after the switch from TM to MA compared with other Ohio MA enrollees (<a href="#aoi230101f1" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Figure</a>, E). Event study results show that
trends in each outcome were generally parallel between Ohio public retirees and other Ohio Humana MA enrollees before the policy change (supporting the use of other Ohio Humana MA enrollees as a comparison group; eResults in
<a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-AOI230101-1">Supplement 1</a>). By the fourth quarter of 2016, inpatient rehabilitation facility admissions had increased by 11.5
percentage points (pp) (95% CI, 5.5 to 17.8; <i>P</i> < .001) and receiving only HH or SNF fell by 9.8 pp (95% CI, −1.2 to −1.4; <i>P</i> = .02).</p> <a class="article-section-id-anchor" id="249487566"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Difference-in-Differences Results </div>
</div>
<a class="article-section-id-anchor" id="249487567"></a>
<p class="para"><a href="#aoi230101t2" class="table-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table 2</a> displays difference-in-differences estimates for PAC and postdischarge patient outcomes. The first column
displays the 2015 mean for Ohio public retirees, followed by separate difference-in-differences estimates for Ohio public retirees compared with other Ohio Humana MA enrollees (comparison group 1) and Ohio public retirees compared
with Kentucky public retirees (comparison group 2). Compared with other Ohio Humana MA enrollees, the percentage of hospitalizations for Ohio public retirees covered by MA decreased by 70.1 (95% CI, −74.2 to −65.9) pp from 2015 to
2016 (<i>P</i> < .001). During the same period, relative to other Ohio Humana MA enrollees, inpatient rehabilitation facility admissions among Ohio public retirees increased by 9.7 (95% CI, 4.7 to 14.7; <i>P</i> < .001) pp and
the percentage of Ohio public retirees receiving only HH or SNF fell by 8.6 (95% CI, −14.6 to −2.6; <i>P</i> = .006) pp; this was nominally driven by reductions in SNF rather than only HH use; however, the estimates were
statistically insignificant. There was no change in the overall probability of using PAC. We found similar relative changes in PAC use comparing Ohio public retirees to Kentucky public retirees, although there was a nominally
larger, but statistically insignificant, reduction in receiving no PAC, and the reduction in use of SNF or HH without IRF was also statistically insignificant.</p> <a class="article-section-id-anchor" id="249487569"></a>
<p class="para">We assessed 2 measures of readmissions: the first included readmissions identified in MedPAR occurring in short-term acute care hospitals that are required to submit information-only claims to Medicare for MA
enrollees. The second included all acute care and critical access hospital readmissions identified in MedPAR as well as hospital readmissions identified in HEDIS data (for MA enrollees). Despite the increased intensity of PAC use
after Ohio public retirees switched from MA to TM, we found no relative change in hospital readmissions across readmission measures and comparison groups.</p> <a class="article-section-id-anchor" id="249487570"></a>
<p class="para">In the 30 days after hospital discharge, the Medicare beneficiaries in the sample were in 1 of 4 mutually exclusive and exhaustive states: (1) in the community, (2) readmitted to hospital, (3) in a PAC facility or
nursing home, or (4) deceased. We investigated the number of days-stay in each state for Ohio public retirees and the 2 comparison groups. We found statistically significant reductions in the number of days that Ohio public retirees
resided in the community during the first 30 days after hospital discharge (−1.6 [95% CI, −2.9 to −0.3] and −2.5 [95% CI, −4.9 to −0.1]) days for comparison groups 1 and 2, respectively. The reduction in community days was nominally
driven by increased days in PAC, but this was only significant when comparing Ohio public retirees with Kentucky public retirees (3.1; 95% CI, 0.9 to 5.3; <i>P</i> = .007) days. We also found no significant change in mortality after
Ohio public retirees switched to TM.</p> <a class="article-section-id-anchor" id="249487571"></a>
<p class="para">Our analysis used an intent-to-treat design, and not all Ohio public retirees switched to TM in 2016 (approximately 25% of hospitalized patients in our sample remained in MA). These 2 groups were similar in terms of
demographic and clinical composition, implying the broader generalizability of the estimates across Ohio public retirees (eResults in
<a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-AOI230101-1">Supplement 1</a>). Changes in PAC use were driven entirely by the Ohio public retirees switching to TM (eResults in
<a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-AOI230101-1">Supplement 1</a>), ruling out that effects were driven by changes in plan design among public retirees electing to
continue coverage with MA. We found nominally larger estimated effects on PAC use for patients with stroke rather than fractures patients, but the differences in the effects were statistically insignificant (eResults in
<a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-AOI230101-1">Supplement 1</a>). We found a similar pattern of results for metropolitan compared with nonmetropolitan counties, although
there was nominal (but statistically insignificant) increase in receiving no PAC for nonmetropolitan counties (eResults in
<a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-AOI230101-1">Supplement 1</a>).</p> <a class="article-section-id-anchor" id="249487572"></a>
<div class="h3 cb section-type-section ">
<div class="heading-text thm-col sb-sc"> Discussion </div>
</div>
<a class="article-section-id-anchor" id="249487573"></a>
<p class="para">When Ohio shifted public retiree health benefits from a mandatory MA plan in 2015 to subsidies for either a MA plan or supplemental coverage for TM, most retirees switched to TM. This natural experiment provided a
unique opportunity to identify the association of MA with PAC use and outcomes for Medicare beneficiaries. We found that, under TM, Ohio public retirees were more likely to be discharged to a more intensive and expensive IRF and
less likely to receive only SNF or HH. However, despite receiving more intensive PAC under TM, hospital readmissions and 30-day mortality for Ohio public retirees were unchanged. Because of the direct mechanical association with
more days spent in PAC facilities, days in the community during the 30 days postdischarge were reduced under TM.</p> <a class="article-section-id-anchor" id="249487574"></a>
<p class="para">The finding that Ohio public retirees were more likely to be discharged to an IRF under TM is consistent with the findings of prior cross-sectional studies comparing MA with TM, which found lower use of PAC overall in
MA,<sup><a href="#aoi230101r7" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">7</a></sup><sup>,<a href="#aoi230101r8" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">8</a>,<a href="#aoi230101r22" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">22</a></sup>
shorter stays in SNFs with fewer therapy minutes,<sup><a href="#aoi230101r23" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">23</a></sup> lower use of postacute
HH,<sup><a href="#aoi230101r7" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">7</a></sup><sup>,<a href="#aoi230101r24" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">24</a></sup>
lower use of
IRF,<sup><a href="#aoi230101r7" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">7</a></sup><sup>,<a href="#aoi230101r8" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">8</a></sup>
and evidence of substitution of SNF for IRF care after stroke and joint replacement
hospitalizations.<sup><a href="#aoi230101r7" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">7</a></sup><sup>,<a href="#aoi230101r8" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">8</a></sup>
</p> <a class="article-section-id-anchor" id="249487575"></a>
<p class="para">A key contribution of our research is showing that MA vs TM differences in IRF use reflect different approaches to providing PAC rather than patient-level selection into MA. However, an important unanswered question
raised by this and previous studies is whether the reduced use of IRFs in MA results from case-by-case “active management” that tries to match each patient to the most appropriate type of PAC or from general restrictions—eg, through
the exclusion of IRFs from plans’ networks—that can only be overcome with extensive effort, persistence, and clinical justification. Notably, the available benefits documentation for the sponsored MA plan in our study did not
mention IRF services.</p> <a class="article-section-id-anchor" id="249487576"></a>
<p class="para">Barnett et al<sup><a href="#aoi230101r25" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">25</a></sup> previously noted that TM payment reforms, such as Accountable Care Organizations and
bundled payment and MA plans generate savings by reducing the use of PAC, which may have adverse effects on patients and caregivers. Moreover, the concern with the lower use of IRF in MA is that beneficiaries who would benefit from
the more intensive rehabilitation services may not be allowed access to these services. We found that when compared with MA, TM did not affect hospital readmissions or 30-day mortality for Ohio public retirees. However, long-term
improvement in functioning, the main goal of rehabilitation, may occur even without changes in short-term outcomes such as hospital readmission and 30-day mortality.</p> <a class="article-section-id-anchor" id="249487577"></a>
<p class="para">As noted earlier, prior studies of TM
beneficiaries<sup><a href="#aoi230101r3" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">3</a></sup><sup>,<a href="#aoi230101r4" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">4</a></sup>
found that patients with hip fracture or stroke were more likely to be alive and residing in the community at 120 days after hospital discharge when they received rehabilitation care in IRFs compared with SNFs, and that patients
admitted to IRFs had better mobility and ability to perform self-care activities than patients in SNFs. Other recent research using the US National Health and Aging Trends
Study<sup><a href="#aoi230101r22" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">22</a></sup> found that MA enrollees had less functional improvement during postacute care use. More causal evidence is
needed on the effects of MA compared with those of TM for a broader set of functional outcomes over a longer study period.</p> <a class="article-section-id-anchor" id="249487578"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Limitations </div>
</div>
<a class="article-section-id-anchor" id="249487579"></a>
<p class="para">This analysis had limitations. First, hospital readmissions and community residence at 30 days after discharge do not fully capture postdischarge functional status. Future work should consider the longer-term effects
of less-intensive PAC on beneficiaries’ functional status and on the well-being of caregivers. Second, a key unanswered question for future research is the mechanisms by which MA plans change PAC use, eg, whether this is done using
prior authorization, more active discharge planning, or as previously suggested, narrower facility and clinician networks that largely exclude IRFs. Third, we selected conditions for which intensive rehabilitation is less
discretionary after a hospitalization; the association of MA with PAC use may differ for other conditions requiring less rehabilitation.</p> <a class="article-section-id-anchor" id="249487580"></a>
<div class="h3 cb section-type-section ">
<div class="heading-text thm-col sb-sc"> Conclusions </div>
</div>
<a class="article-section-id-anchor" id="249487581"></a>
<p class="para">This cohort study found that after a change in retiree health benefit policy, most Ohio public retirees shifted from MA to TM and received more intensive PAC with no significant change in the measured short-term
postdischarge outcomes. Future work should consider measures of postacute functional status over a longer follow-up period.</p> <a class="article-section-id-anchor" id="249487582"></a>
<div class="h3 cb section-type-acknowledgements has-back-to-top">
<a href="#top" class="section-jump-link back-to-top" data-tab-toggle=".tab-nav-full-text">Back to top</a>
<div class="heading-text thm-col sb-sc"> Article Information </div>
</div>
<p class="para"><strong>Accepted for Publication:</strong> December 13, 2023.</p>
<p class="parapublished-online"><strong>Published:</strong> February 16, 2024. doi:10.1001/jamahealthforum.2023.5325</p>
<p class="paraopen-access-note"><strong>Open Access:</strong> This is an open access article distributed under the terms of the <a href="https://jamanetwork.com/pages/cc-by-license-permissions">CC-BY License</a>. © 2024 Huckfeldt PJ
et al. <i>JAMA Health Forum</i>.</p>
<p class="authorInfoSection"><strong>Corresponding Author:</strong> Peter J. Huckfeldt, PhD, Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE, MMC 729, Minneapolis, MN 55455
(<a href="mailto:huckfeld@umn.edu" target="_blank">huckfeld@umn.edu</a>).</p>
<p class="paraauthor-contributions"><strong>Author Contributions:</strong> Dr Huckfeldt had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.</p>
<p class="para"><i>Concept and design:</i> Huckfeldt, Shier, Escarce, Sood.</p>
<p class="para"><i>Acquisition, analysis, or interpretation of data:</i> Huckfeldt, Shier, Rabideau, Boese, Parsons, Sood.</p>
<p class="para"><i>Drafting of the manuscript:</i> Huckfeldt, Escarce.</p>
<p class="para"><i>Critical review of the manuscript for important intellectual content:</i> All authors.</p>
<p class="para"><i>Statistical analysis:</i> Huckfeldt, Shier, Boese.</p>
<p class="para"><i>Obtained funding:</i> Huckfeldt, Sood.</p>
<p class="para"><i>Administrative, technical, or material support:</i> Huckfeldt, Shier, Rabideau, Boese.</p>
<p class="para"><i>Supervision:</i> Huckfeldt, Escarce, Parsons, Sood.</p>
<p class="parafinancial-disclosure"><strong>Conflict of Interest Disclosures:</strong> Dr Huckfeldt reported grants from the National Institute on Aging and the National Institute of Diabetes and Digestive and Kidney Diseases of the
US National Institutes of Health, the Agency for Healthcare Research and Quality, and the Robert Wood Johnson Foundation, and contract funding from the US Centers for Medicare & Medicaid Services. Dr Boese reported funding from
the US Centers for Medicare & Medicaid Services through NORC at the University of Chicago for evaluating the Next Generation Accountable Care Organization model and a grant from The Donaghue Foundation outside the submitted
work. Dr Rabideau reports receiving funding through a training grant from the US National Institute of Mental Health outside the submitted work.Dr Sood reported being a visiting scholar at Amazon.com. No other disclosures were
reported.</p>
<p class="parafunding-statement"><strong>Funding/Support:</strong> This research was supported by the US National Institute on Aging (grant Nos. R01AG071731, R01AG079216, and R01AG046838).</p>
<p class="para"><strong>Role of the Funder/Sponsor:</strong> The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the
manuscript; and decision to submit the manuscript for publication.</p>
<p class="paradata-sharing-statement"><strong>Data Sharing Statement:</strong> See <a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-AOI230101-1">Supplement 2</a>.</p>
<a class="article-section-id-anchor" id="249487583"></a>
<div class="h3 cb section-type-references ">
<div class="heading-text thm-col sb-sc"> References </div>
</div>
<div class="references">
<div class="reference"><a class="reference-number" id="aoi230101r1">1.</a>
<div class="reference-content">Kaiser Family Foundation. Medicare Advantage in 2023: Enrollment Update and Key Trends. Accessed December 1, 2023.
<a href="https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2023-enrollment-update-and-key-trends/">https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2023-enrollment-update-and-key-trends/</a></div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r2">2.</a>
<div class="reference-content">Neuman P, Jacobson GA. Medicare Advantage checkup. <i xmlns:helper="urn:XsltStringHelper"> N Engl J Med</i>. 2018;379(22):2163-2172.
doi:<a href="http://dx.doi.org/10.1056/NEJMhpr1804089">10.1056/NEJMhpr1804089</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30428276" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Medicare%20Advantage%20checkup.&author=P%20Neuman&author=GA%20Jacobson&publication_year=2018&journal=N%20Engl%20J%20Med&volume=379&pages=2163-2172" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1056/NEJMhpr1804089" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r3">3.</a>
<div class="reference-content">Hong I, Goodwin JS, Reistetter TA, et al. Comparison of functional status improvements among patients with stroke receiving postacute care in inpatient rehabilitation
vs skilled nursing facilities. <i xmlns:helper="urn:XsltStringHelper"> JAMA Netw Open</i>. 2019;2(12):e1916646.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamanetworkopen.2019.16646">10.1001/jamanetworkopen.2019.16646</a><br><a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2756256" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/31800069" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Comparison%20of%20functional%20status%20improvements%20among%20patients%20with%20stroke%20receiving%20postacute%20care%20in%20inpatient%20rehabilitation%20vs%20skilled%20nursing%20facilities.&author=I%20Hong&author=JS%20Goodwin&author=TA%20Reistetter&publication_year=2019&journal=JAMA%20Netw%20Open&volume=2&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamanetworkopen.2019.16646" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r4">4.</a>
<div class="reference-content">Buntin MB, Colla CH, Deb P, Sood N, Escarce JJ. Medicare spending and outcomes after postacute care for stroke and hip fracture.
<i xmlns:helper="urn:XsltStringHelper"> Med Care</i>. 2010;48(9):776-784.
doi:<a href="http://dx.doi.org/10.1097/MLR.0b013e3181e359df">10.1097/MLR.0b013e3181e359df</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/20706167" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Medicare%20spending%20and%20outcomes%20after%20postacute%20care%20for%20stroke%20and%20hip%20fracture.&author=MB%20Buntin&author=CH%20Colla&author=P%20Deb&author=N%20Sood&author=JJ%20Escarce&publication_year=2010&journal=Med%20Care&volume=48&pages=776-784" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1097/MLR.0b013e3181e359df" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r5">5.</a>
<div class="reference-content">Werner RM, Coe NB, Qi M, Konetzka RT. Patient outcomes after hospital discharge to home with home health care vs to a skilled nursing facility.
<i xmlns:helper="urn:XsltStringHelper"> JAMA Intern Med</i>. 2019;179(5):617-623.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2018.7998">10.1001/jamainternmed.2018.7998</a><br><a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2727848" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30855652" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Patient%20outcomes%20after%20hospital%20discharge%20to%20home%20with%20home%20health%20care%20vs%20to%20a%20skilled%20nursing%20facility.&author=RM%20Werner&author=NB%20Coe&author=M%20Qi&author=RT%20Konetzka&publication_year=2019&journal=JAMA%20Intern%20Med&volume=179&pages=617-623" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamainternmed.2018.7998" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r6">6.</a>
<div class="reference-content">US Department of Health and Human Services Office of Inspector General. Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to
Medically Necessary Care. Accessed June 8, 2023. <a href="https://oig.hhs.gov/oei/reports/OEI-09-18-00260.asp">https://oig.hhs.gov/oei/reports/OEI-09-18-00260.asp</a></div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r7">7.</a>
<div class="reference-content">Skopec L, Huckfeldt PJ, Wissoker D, et al. Home health and postacute care use in Medicare Advantage and traditional Medicare.
<i xmlns:helper="urn:XsltStringHelper"> Health Aff (Millwood)</i>. 2020;39(5):837-842.
doi:<a href="http://dx.doi.org/10.1377/hlthaff.2019.00844">10.1377/hlthaff.2019.00844</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32364874" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Home%20health%20and%20postacute%20care%20use%20in%20Medicare%20Advantage%20and%20traditional%20Medicare.&author=L%20Skopec&author=PJ%20Huckfeldt&author=D%20Wissoker&publication_year=2020&journal=Health%20Aff%20%28Millwood%29&volume=39&pages=837-842" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1377/hlthaff.2019.00844" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r8">8.</a>
<div class="reference-content">Huckfeldt PJ, Escarce JJ, Rabideau B, Karaca-Mandic P, Sood N. Less intense postacute care, better outcomes for enrollees in Medicare Advantage than those in
fee-for-service. <i xmlns:helper="urn:XsltStringHelper"> Health Aff (Millwood)</i>. 2017;36(1):91-100.
doi:<a href="http://dx.doi.org/10.1377/hlthaff.2016.1027">10.1377/hlthaff.2016.1027</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/28069851" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Less%20intense%20postacute%20care%2C%20better%20outcomes%20for%20enrollees%20in%20Medicare%20Advantage%20than%20those%20in%20fee-for-service.&author=PJ%20Huckfeldt&author=JJ%20Escarce&author=B%20Rabideau&author=P%20Karaca-Mandic&author=N%20Sood&publication_year=2017&journal=Health%20Aff%20%28Millwood%29&volume=36&pages=91-100" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1377/hlthaff.2016.1027" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r9">9.</a>
<div class="reference-content">Newhouse JP, Price M, McWilliams JM, Hsu J, Souza J, Landon BE. Adjusted mortality rates are lower for Medicare Advantage than traditional Medicare,
but the rates converge over time. <i xmlns:helper="urn:XsltStringHelper"> Health Aff (Millwood)</i>. 2019;38(4):554-560.
doi:<a href="http://dx.doi.org/10.1377/hlthaff.2018.05390">10.1377/hlthaff.2018.05390</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30933606" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Adjusted%20mortality%20rates%20are%20lower%20for%20Medicare%20Advantage%20than%20traditional%20Medicare%2C%20but%20the%20rates%20converge%20over%20time.&author=JP%20Newhouse&author=M%20Price&author=JM%20McWilliams&author=J%20Hsu&author=J%20Souza&author=BE%20Landon&publication_year=2019&journal=Health%20Aff%20%28Millwood%29&volume=38&pages=554-560" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1377/hlthaff.2018.05390" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r10">10.</a>
<div class="reference-content">Ohio Public Retirees Retirement System. 2015 OPERS HealthCare Medicare Guide. 2014. <a href="https://www.opers.org/">https://www.opers.org/</a></div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r11">11.</a>
<div class="reference-content">Cooper KB, Mears SC, Siegel ER, Stambough JB, Bumpass DB, Cherney SM. The hip and femur fracture bundle: preliminary findings from a tertiary
hospital. <i xmlns:helper="urn:XsltStringHelper"> J Arthroplasty</i>. 2022;37(8S):S761-S765.
doi:<a href="http://dx.doi.org/10.1016/j.arth.2022.03.059">10.1016/j.arth.2022.03.059</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/35314286" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20hip%20and%20femur%20fracture%20bundle%3A%20preliminary%20findings%20from%20a%20tertiary%20hospital.&author=KB%20Cooper&author=SC%20Mears&author=ER%20Siegel&author=JB%20Stambough&author=DB%20Bumpass&author=SM%20Cherney&publication_year=2022&journal=J%20Arthroplasty&volume=37&pages=S761-S765" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.arth.2022.03.059" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r12">12.</a>
<div class="reference-content">US Health and Human Services. CMS Comprehensive Joint Replacement program.
<a href="https://www.hhs.gov/guidance/document/cjr-icd-9-and-icd-10-hip-fracture-diagnosis-codes">https://www.hhs.gov/guidance/document/cjr-icd-9-and-icd-10-hip-fracture-diagnosis-codes</a> </div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r13">13.</a>
<div class="reference-content">Medicare Payment Advisory Commission. Inpatient Rehabilitation Facilities Payment System. Published 2021. Accessed July 27, 2023.
<a href="https://www.medpac.gov/wp-content/uploads/2021/11/medpac_payment_basics_21_irf_final_sec.pdf">https://www.medpac.gov/wp-content/uploads/2021/11/medpac_payment_basics_21_irf_final_sec.pdf</a></div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r14">14.</a>
<div class="reference-content">Ohio Public Retirees Retirement System. Open Enrollment Guide 2016. Published 2015. Accessed December 1, 2023.
<a href="https://www.opers.org/pubs-archive/healthcare/open/2016/2016openenrollmentguide.pdf">https://www.opers.org/pubs-archive/healthcare/open/2016/2016openenrollmentguide.pdf</a></div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r15">15.</a>
<div class="reference-content">US Centers for Medicare & Medicaid Services. Capturing days on which Medicare beneficiaries are entitled to Medicare Advantage (MA) in the Medicare/Supplemental Security Income (SSI) fraction.
Published 2007. Accessed July 27, 2023.
<a href="https://www.hhs.gov/guidance/document/capturing-days-which-medicare-beneficiaries-are-entitled-medicare-advantage-ma">https://www.hhs.gov/guidance/document/capturing-days-which-medicare-beneficiaries-are-entitled-medicare-advantage-ma</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r16">16.</a>
<div class="reference-content">ResDAC. Identifying Medicare Managed Care Beneficiaries from the Master Beneficiary Summary or Denominator Files. Published 2021. Accessed July 28, 2023.
<a href="https://resdac.org/articles/identifying-medicare-managed-care-beneficiaries-master-beneficiary-summary-or-denominator">https://resdac.org/articles/identifying-medicare-managed-care-beneficiaries-master-beneficiary-summary-or-denominator</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r17">17.</a>
<div class="reference-content">US Centers for Medicare & Medicaid Services. Home Health Quality Reporting Program. Published 2023. Accessed November 30, 2023.
<a href="https://www.cms.gov/medicare/quality/home-health">https://www.cms.gov/medicare/quality/home-health</a></div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r18">18.</a>
<div class="reference-content">Geruso M, Layton T. Upcoding: evidence from Medicare on Squishy risk adjustment. <i xmlns:helper="urn:XsltStringHelper"> J Polit Econ</i>. 2020;12(3):984-1026.
doi:<a href="http://dx.doi.org/10.1086/704756">10.1086/704756</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32719571" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Upcoding%3A%20evidence%20from%20Medicare%20on%20Squishy%20risk%20adjustment.&author=M%20Geruso&author=T%20Layton&publication_year=2020&journal=J%20Polit%20Econ&volume=12&pages=984-1026" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1086/704756" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r19">19.</a>
<div class="reference-content">US National Cancer Institute. Health Service Areas. Published 2008. Accessed December 1, 2023.
<a href="https://seer.cancer.gov/seerstat/variables/countyattribs/hsa.html">https://seer.cancer.gov/seerstat/variables/countyattribs/hsa.html</a></div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r20">20.</a>
<div class="reference-content">US Department of Agriculture Economic Research Service. Rural-Urban Continuum Codes. Published 2023. Accessed November 30, 2023.
<a href="https://www.ers.usda.gov/data-products/rural-urban-continuum-codes/">https://www.ers.usda.gov/data-products/rural-urban-continuum-codes/</a></div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r21">21.</a>
<div class="reference-content">Cupp MA, Beaudoin FL, Hayes KN, et al. Post-acute care setting after hip fracture hospitalization and subsequent opioid use in older adults.
<i xmlns:helper="urn:XsltStringHelper"> J Am Med Dir Assoc</i>. 2023;24(7):971-977.e4.
doi:<a href="http://dx.doi.org/10.1016/j.jamda.2023.03.012">10.1016/j.jamda.2023.03.012</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/37080246" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Post-acute%20care%20setting%20after%20hip%20fracture%20hospitalization%20and%20subsequent%20opioid%20use%20in%20older%20adults.&author=MA%20Cupp&author=FL%20Beaudoin&author=KN%20Hayes&publication_year=2023&journal=J%20Am%20Med%20Dir%20Assoc&volume=24&pages=971-977.e4" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jamda.2023.03.012" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r22">22.</a>
<div class="reference-content">Achola EM, Stevenson DG, Keohane LM. Postacute care services use and outcomes among traditional Medicare and Medicare Advantage beneficiaries.
<i xmlns:helper="urn:XsltStringHelper"> JAMA Health Forum</i>. 2023;4(8):e232517.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamahealthforum.2023.2517">10.1001/jamahealthforum.2023.2517</a><br><a href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2808465" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/37594745" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Postacute%20care%20services%20use%20and%20outcomes%20among%20traditional%20Medicare%20and%20Medicare%20Advantage%20beneficiaries.&author=EM%20Achola&author=DG%20Stevenson&author=LM%20Keohane&publication_year=2023&journal=JAMA%20Health%20Forum&volume=4&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamahealthforum.2023.2517" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r23">23.</a>
<div class="reference-content">Kumar A, Rahman M, Trivedi AN, Resnik L, Gozalo P, Mor V. Comparing post-acute rehabilitation use, length of stay, and outcomes experienced by Medicare
fee-for-service and Medicare Advantage beneficiaries with hip fracture in the United States: a secondary analysis of administrative data. <i xmlns:helper="urn:XsltStringHelper"> PLoS Med</i>. 2018;15(6):e1002592.
doi:<a href="http://dx.doi.org/10.1371/journal.pmed.1002592">10.1371/journal.pmed.1002592</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/29944655" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Comparing%20post-acute%20rehabilitation%20use%2C%20length%20of%20stay%2C%20and%20outcomes%20experienced%20by%20Medicare%20fee-for-service%20and%20Medicare%20Advantage%20beneficiaries%20with%20hip%20fracture%20in%20the%20United%20States%3A%20a%20secondary%20analysis%20of%20administrative%20data.&author=A%20Kumar&author=M%20Rahman&author=AN%20Trivedi&author=L%20Resnik&author=P%20Gozalo&author=V%20Mor&publication_year=2018&journal=PLoS%20Med&volume=15&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1371/journal.pmed.1002592" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r24">24.</a>
<div class="reference-content">Loomer L, Kosar CM, Meyers DJ, Thomas KS. Comparing receipt of prescribed post-acute home health care between Medicare Advantage and traditional Medicare
beneficiaries: an observational study. <i xmlns:helper="urn:XsltStringHelper"> J Gen Intern Med</i>. 2021;36(8):2323-2331.
doi:<a href="http://dx.doi.org/10.1007/s11606-020-06282-3">10.1007/s11606-020-06282-3</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33051838" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Comparing%20receipt%20of%20prescribed%20post-acute%20home%20health%20care%20between%20Medicare%20Advantage%20and%20traditional%20Medicare%20beneficiaries%3A%20an%20observational%20study.&author=L%20Loomer&author=CM%20Kosar&author=DJ%20Meyers&author=KS%20Thomas&publication_year=2021&journal=J%20Gen%20Intern%20Med&volume=36&pages=2323-2331" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1007/s11606-020-06282-3" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="aoi230101r25">25.</a>
<div class="reference-content">Barnett ML, Mehrotra A, Grabowski DC. Postacute care: the piggy bank for savings in alternative payment models?
<i xmlns:helper="urn:XsltStringHelper"> N Engl J Med</i>. 2019;381(4):302-303.
doi:<a href="http://dx.doi.org/10.1056/NEJMp1901896">10.1056/NEJMp1901896</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/31340092" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Postacute%20care%3A%20the%20piggy%20bank%20for%20savings%20in%20alternative%20payment%20models%3F&author=ML%20Barnett&author=A%20Mehrotra&author=DC%20Grabowski&publication_year=2019&journal=N%20Engl%20J%20Med&volume=381&pages=302-303" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1056/NEJMp1901896" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
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[Skip to Navigation] Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Health Forum HomeNew OnlineIssuesFor Authors Podcast JAMA+ AI JOURNALS JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2024 American Medical Association. All Rights Reserved Search All * Search All * JAMA * JAMA Network Open * JAMA Cardiology * JAMA Dermatology * JAMA Forum Archive * JAMA Health Forum * JAMA Internal Medicine * JAMA Neurology * JAMA Oncology * JAMA Ophthalmology * JAMA Otolaryngology–Head & Neck Surgery * JAMA Pediatrics * JAMA Psychiatry * JAMA Surgery * Archives of Neurology & Psychiatry Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In full text icon Full Text contents icon Contents figure icon Figures / Tables multimedia icon Multimedia attach icon Supplemental Content references icon References related icon Related comments icon Comments Download PDF Comment Top of Article * Key Points * Abstract * Introduction * Methods * Results * Discussion * Conclusions * Article Information * References Video Player is loading. Play Video PlaySkip BackwardSkip Forward Mute Current Time 0:00 / Duration 0:59 Loaded: 16.56% 0:00 Stream Type LIVE Seek to live, currently behind liveLIVE Remaining Time -0:59 1x Playback Rate Chapters * Chapters Descriptions * descriptions off, selected Captions * captions settings, opens captions settings dialog * captions off, selected Audio Track * en (Main), selected This is a modal window. Beginning of dialog window. Escape will cancel and close the window. TextColorWhiteBlackRedGreenBlueYellowMagentaCyanOpacityOpaqueSemi-TransparentText BackgroundColorBlackWhiteRedGreenBlueYellowMagentaCyanOpacityOpaqueSemi-TransparentTransparentCaption Area BackgroundColorBlackWhiteRedGreenBlueYellowMagentaCyanOpacityTransparentSemi-TransparentOpaque Font Size50%75%100%125%150%175%200%300%400%Text Edge StyleNoneRaisedDepressedUniformDrop shadowFont FamilyProportional Sans-SerifMonospace Sans-SerifProportional SerifMonospace SerifCasualScriptSmall Caps ResetDone Close Modal Dialog End of dialog window. Close Modal Dialog This is a modal window. This modal can be closed by pressing the Escape key or activating the close button. Explore JAMA+ AI Figure. Adjusted Medicare Advantage (MA) Coverage, Postacute Care Use, and Patient Outcomes, 2015-2016 View LargeDownload When MA coverage (A) was more than 99% but less than 100%, we plotted 99% to ensure sample sizes greater than 12. Table 1. Comparison of Characteristics of Hospitalized Retirees With Public Insurance, by Study Group, 2015 vs 2016 View LargeDownload Table 2. Difference-in-Difference Estimates for Medicare Advantage (MA) Coverage and Postacute Care Use View LargeDownload Supplement 1. eAppendix eResults. Supplement 2. Data Sharing Statement 1. Kaiser Family Foundation. Medicare Advantage in 2023: Enrollment Update and Key Trends. Accessed December 1, 2023. https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2023-enrollment-update-and-key-trends/ 2. Neuman P, Jacobson GA. Medicare Advantage checkup. N Engl J Med. 2018;379(22):2163-2172. doi:10.1056/NEJMhpr1804089PubMedGoogle ScholarCrossref 3. Hong I, Goodwin JS, Reistetter TA, et al. Comparison of functional status improvements among patients with stroke receiving postacute care in inpatient rehabilitation vs skilled nursing facilities. JAMA Netw Open. 2019;2(12):e1916646. doi:10.1001/jamanetworkopen.2019.16646 ArticlePubMedGoogle ScholarCrossref 4. Buntin MB, Colla CH, Deb P, Sood N, Escarce JJ. Medicare spending and outcomes after postacute care for stroke and hip fracture. Med Care. 2010;48(9):776-784. doi:10.1097/MLR.0b013e3181e359dfPubMedGoogle ScholarCrossref 5. Werner RM, Coe NB, Qi M, Konetzka RT. Patient outcomes after hospital discharge to home with home health care vs to a skilled nursing facility. JAMA Intern Med. 2019;179(5):617-623. doi:10.1001/jamainternmed.2018.7998 ArticlePubMedGoogle ScholarCrossref 6. US Department of Health and Human Services Office of Inspector General. Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care. Accessed June 8, 2023. https://oig.hhs.gov/oei/reports/OEI-09-18-00260.asp 7. Skopec L, Huckfeldt PJ, Wissoker D, et al. Home health and postacute care use in Medicare Advantage and traditional Medicare. Health Aff (Millwood). 2020;39(5):837-842. doi:10.1377/hlthaff.2019.00844PubMedGoogle ScholarCrossref 8. Huckfeldt PJ, Escarce JJ, Rabideau B, Karaca-Mandic P, Sood N. Less intense postacute care, better outcomes for enrollees in Medicare Advantage than those in fee-for-service. Health Aff (Millwood). 2017;36(1):91-100. doi:10.1377/hlthaff.2016.1027PubMedGoogle ScholarCrossref 9. Newhouse JP, Price M, McWilliams JM, Hsu J, Souza J, Landon BE. Adjusted mortality rates are lower for Medicare Advantage than traditional Medicare, but the rates converge over time. Health Aff (Millwood). 2019;38(4):554-560. doi:10.1377/hlthaff.2018.05390PubMedGoogle ScholarCrossref 10. Ohio Public Retirees Retirement System. 2015 OPERS HealthCare Medicare Guide. 2014. https://www.opers.org/ 11. Cooper KB, Mears SC, Siegel ER, Stambough JB, Bumpass DB, Cherney SM. The hip and femur fracture bundle: preliminary findings from a tertiary hospital. J Arthroplasty. 2022;37(8S):S761-S765. doi:10.1016/j.arth.2022.03.059PubMedGoogle ScholarCrossref 12. US Health and Human Services. CMS Comprehensive Joint Replacement program. https://www.hhs.gov/guidance/document/cjr-icd-9-and-icd-10-hip-fracture-diagnosis-codes 13. Medicare Payment Advisory Commission. Inpatient Rehabilitation Facilities Payment System. Published 2021. Accessed July 27, 2023. https://www.medpac.gov/wp-content/uploads/2021/11/medpac_payment_basics_21_irf_final_sec.pdf 14. Ohio Public Retirees Retirement System. Open Enrollment Guide 2016. Published 2015. Accessed December 1, 2023. https://www.opers.org/pubs-archive/healthcare/open/2016/2016openenrollmentguide.pdf 15. US Centers for Medicare & Medicaid Services. Capturing days on which Medicare beneficiaries are entitled to Medicare Advantage (MA) in the Medicare/Supplemental Security Income (SSI) fraction. Published 2007. Accessed July 27, 2023. https://www.hhs.gov/guidance/document/capturing-days-which-medicare-beneficiaries-are-entitled-medicare-advantage-ma 16. ResDAC. Identifying Medicare Managed Care Beneficiaries from the Master Beneficiary Summary or Denominator Files. Published 2021. Accessed July 28, 2023. https://resdac.org/articles/identifying-medicare-managed-care-beneficiaries-master-beneficiary-summary-or-denominator 17. US Centers for Medicare & Medicaid Services. Home Health Quality Reporting Program. Published 2023. Accessed November 30, 2023. https://www.cms.gov/medicare/quality/home-health 18. Geruso M, Layton T. Upcoding: evidence from Medicare on Squishy risk adjustment. J Polit Econ. 2020;12(3):984-1026. doi:10.1086/704756PubMedGoogle ScholarCrossref 19. US National Cancer Institute. Health Service Areas. Published 2008. Accessed December 1, 2023. https://seer.cancer.gov/seerstat/variables/countyattribs/hsa.html 20. US Department of Agriculture Economic Research Service. Rural-Urban Continuum Codes. Published 2023. Accessed November 30, 2023. https://www.ers.usda.gov/data-products/rural-urban-continuum-codes/ 21. Cupp MA, Beaudoin FL, Hayes KN, et al. Post-acute care setting after hip fracture hospitalization and subsequent opioid use in older adults. J Am Med Dir Assoc. 2023;24(7):971-977.e4. doi:10.1016/j.jamda.2023.03.012PubMedGoogle ScholarCrossref 22. Achola EM, Stevenson DG, Keohane LM. Postacute care services use and outcomes among traditional Medicare and Medicare Advantage beneficiaries. JAMA Health Forum. 2023;4(8):e232517. doi:10.1001/jamahealthforum.2023.2517 ArticlePubMedGoogle ScholarCrossref 23. Kumar A, Rahman M, Trivedi AN, Resnik L, Gozalo P, Mor V. Comparing post-acute rehabilitation use, length of stay, and outcomes experienced by Medicare fee-for-service and Medicare Advantage beneficiaries with hip fracture in the United States: a secondary analysis of administrative data. PLoS Med. 2018;15(6):e1002592. doi:10.1371/journal.pmed.1002592PubMedGoogle ScholarCrossref 24. Loomer L, Kosar CM, Meyers DJ, Thomas KS. Comparing receipt of prescribed post-acute home health care between Medicare Advantage and traditional Medicare beneficiaries: an observational study. J Gen Intern Med. 2021;36(8):2323-2331. doi:10.1007/s11606-020-06282-3PubMedGoogle ScholarCrossref 25. Barnett ML, Mehrotra A, Grabowski DC. Postacute care: the piggy bank for savings in alternative payment models? N Engl J Med. 2019;381(4):302-303. doi:10.1056/NEJMp1901896PubMedGoogle ScholarCrossref * CMS and Lawmakers Take Action on Medicare Advantage Prior Authorization JAMA Medical News & Perspectives September 24, 2024 This Medical News article discusses care denials under Medicare Advantage plans and efforts to streamline the prior authorization process. Eli Cahan, MD, MSc SEE MORE ABOUT Health Policy Health Care Economics, Insurance, Payment TRENDING * Differences in Inpatient Rehabilitation Services Between US Medicare Advantage and Traditional Medicare JAMA Network Open Research March 18, 2020 * Rural-Urban Differences in Postacute Care Utilization and Outcomes Among Older US Adults JAMA Network Open Research January 8, 2020 * Variation in Rates of 30-Day Hospital Readmission After Discharge From Inpatient Rehabilitation JAMA Network Open Research December 13, 2019 -------------------------------------------------------------------------------- SELECT YOUR INTERESTS * Academic Medicine * Acid Base, Electrolytes, Fluids * Allergy and Clinical Immunology * American Indian or Alaska Natives * Anesthesiology * Anticoagulation * Art and Images in Psychiatry * Artificial Intelligence * Assisted Reproduction * Bleeding and Transfusion * Cardiology * Caring for the Critically Ill Patient * Challenges in Clinical Electrocardiography * Climate and Health * Climate Change * Clinical Challenge * Clinical Decision Support * Clinical Implications of Basic Neuroscience * Clinical Pharmacy and Pharmacology * Coaching * Complementary and Alternative Medicine * Consensus Statements * Coronavirus (COVID-19) * Critical Care Medicine * Cultural Competency * Dental Medicine * Dermatology * Diabetes and Endocrinology * Diagnostic Test Interpretation * Digital Health * Drug Development * Electronic Health Records * Emergency Medicine * End of Life, Hospice, Palliative Care * Environmental Health * Equity, Diversity, and Inclusion * Ethics * Facial Plastic Surgery * Gastroenterology and Hepatology * Genetics and Genomics * Genomics and Precision Health * Geriatrics * Global Health * Guide to Statistics and Methods * Guidelines * Hair Disorders * Health Care Delivery Models * Health Care Economics, Insurance, Payment * Health Care Quality * Health Care Reform * Health Care Safety * Health Care Workforce * Health Disparities * Health Inequities * Health Policy * Health Systems Science * Hematology * History of Medicine * Humanities * Hypertension * Images in Neurology * Implementation Science * Infectious Diseases * Innovations in Health Care Delivery * JAMA Forum * JAMA Infographic * Law and Medicine * Leading Change * Less is More * LGBTQIA Medicine * Lifestyle Behaviors * Medical Coding * Medical Devices and Equipment * Medical Education * Medical Education and Training * Medical Journals and Publishing * Melanoma * Mobile Health and Telemedicine * Narrative Medicine * Nephrology * Neurology * Neuroscience and Psychiatry * Notable Notes * Nursing * Nutrition * Nutrition, Obesity, Exercise * Obesity * Obstetrics and Gynecology * Occupational Health * Oncology * Ophthalmology * Orthopedics * Otolaryngology * Pain Medicine * Palliative Care * Pathology and Laboratory Medicine * Patient Care * Patient Information * Pediatrics * Performance Improvement * Performance Measures * Perioperative Care and Consultation * Pharmacoeconomics * Pharmacoepidemiology * Pharmacogenetics * Pharmacy and Clinical Pharmacology * Physical Medicine and Rehabilitation * Physical Therapy * Physician Leadership * Poetry * Population Health * Primary Care * Professional Well-being * Professionalism * Psychiatry and Behavioral Health * Public Health * Pulmonary Medicine * Radiology * Regulatory Agencies * Reproductive Health * Research, Methods, Statistics * Resuscitation * Rheumatology * Risk Management * Scientific Discovery and the Future of Medicine * Sexual Health * Shared Decision Making and Communication * Sleep Medicine * Sports Medicine * Stem Cell Transplantation * Substance Use and Addiction Medicine * Surgery * Surgical Innovation * Surgical Pearls * Teachable Moment * Technology and Finance * The Art of JAMA * The Arts and Medicine * The Rational Clinical Examination * Tobacco and e-Cigarettes * Toxicology * Translational Medicine * Trauma and Injury * Treatment Adherence * Ultrasonography * Urology * Users' Guide to the Medical Literature * Vaccination * Venous Thromboembolism * Veterans Health * Violence * Women's Health * Workflow and Process * Wound Care, Infection, Healing Save Preferences Privacy Policy | Terms of Use OTHERS ALSO LIKED We recommend * Comparison of prior authorization across insurers: cross sectional evidence from Medicare Advantage Ravi Gupta, The BMJ, 2024 * Medicare's new prescription drug plan causes confusion Fred Charatan, The BMJ, 2005 * Postoperative patients fare better when readmitted to the hospital where they had surgery, study finds Michael McCarthy, The BMJ, 2014 * Association between Medicare eligibility at age 65 years and in-hospital treatment patterns and health outcomes for patients with trauma: regression discontinui... Deepon Bhaumik, The BMJ, 2023 Powered by * Privacy policy * Google Analytics settings Comment 1 Comment for this article EXPAND ALL February 27, 2024 Medicare Advantage restricts patient care, while costing us more Linda Burke, Ph.D. | Elmhurst University The authors appropriately refrain from claiming equal outcomes for MA and TM patients in postacute care, based only 30 days of follow-up post-hospitalization. They appropriately note that other studies have found better outcomes following the inpatient rehabilitation facility (IRF) that is more available to TM patients, versus its near-inaccessibility to patients in MA. However, the article is based on an implied premise that is just not true: that by withholding more care from more patients, MA is saving taxpayer dollars. In fact, MA is 6 percent more expensive per patient than TM. This is because MA is not Medicare, but a private, for-profit insurance plan. Profits are made by restricting care, limited networks, and overcoding. Other reasons for the higher cost of MA, versus TM, are the payment upfront to the insurance company for each new MA enrollee; and also the twice-as-high commission paid to insurance brokers for selling a MA plan, versus a TM plan. (1) Any discussion of outcomes under TM versus MA is incomplete without acknowledging that MA is costing us more than TM, while seriously restricting patients' access to care. (1) J. Jacobson and D. Blumenthal. The Predominance of Medicare Advantage. N Engl J Med 2023; 389:2291-2298 (December 14, 2023) CONFLICT OF INTEREST: None Reported READ MORE This Issue Views 5,386 Citations 0 35 Comments 1 View Metrics * Download PDF * X Facebook More LinkedIn * Cite This CITATION Huckfeldt PJ, Shier V, Escarce JJ, et al. Postacute Care for Medicare Advantage Enrollees Who Switched to Traditional Medicare Compared With Those Who Remained in Medicare Advantage. JAMA Health Forum. 2024;5(2):e235325. doi:10.1001/jamahealthforum.2023.5325 MANAGE CITATIONS: Ris (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager Mendeley © 2024 * Permissions Original Investigation February 16, 2024 POSTACUTE CARE FOR MEDICARE ADVANTAGE ENROLLEES WHO SWITCHED TO TRADITIONAL MEDICARE COMPARED WITH THOSE WHO REMAINED IN MEDICARE ADVANTAGE Peter J. Huckfeldt, PhD1; Victoria Shier, PhD2,7; José J. Escarce, MD, PhD3,4; et al Brendan Rabideau, PhD5,6; Tyler Boese, MS1; Helen M. Parsons, PhD1; Neeraj Sood, PhD2,7 Author Affiliations Article Information * 1Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis * 2Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles * 3Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles * 4Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles * 5Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland * 6Analysis Group, Inc, Los Angeles, California * 7Department of Health Policy and Management, Sol Price School of Public Policy, University of Southern California, Los Angeles JAMA Health Forum. 2024;5(2):e235325. doi:10.1001/jamahealthforum.2023.5325 visual abstract icon Visual Abstract editorial comment icon Editorial Comment related articles icon Related Articles author interview icon Interviews multimedia icon Multimedia audio icon Listen to this article * Medical News & Perspectives CMS and Lawmakers Take Action on Medicare Advantage Prior Authorization Eli Cahan, MD, MSc JAMA Key Points Question What is the association of Medicare Advantage (MA) enrollment with postacute care use and patient outcomes among retired state employees? Findings This cohort study using Medicare data including 4613 hospitalizations of retired Ohio state employees found that after a mandatory MA plan was discontinued, enrollees who switched to traditional Medicare received more intensive postacute care. No changes in 30-day hospital readmissions or mortality were observed. Meaning This finding suggests that MA plans provided less intensive postacute care than traditional Medicare, with no significant difference in measured short-term outcomes; measures of postacute functional status over a longer follow-up period are needed. Abstract Importance Medicare Advantage (MA) plans receive capitated per enrollee payments that create financial incentives to provide care more efficiently than traditional Medicare (TM); however, incentives could be associated with MA plans reducing use of beneficial services. Postacute care can improve functional status, but it is costly, and thus may be provided differently to Medicare beneficiaries by MA plans compared with TM. Objective To estimate the association of MA compared with TM enrollment with postacute care use and postdischarge outcomes. Design, Setting, and Participants This was a cohort study using Medicare data on 4613 hospitalizations among retired Ohio state employees and 2 comparison groups in 2015 and 2016. The study investigated the association of a policy change with use of postacute care and outcomes. The policy changed state retiree health benefits in Ohio from a mandatory MA plan to subsidies for either supplemental TM coverage or an MA plan. After policy implementation, approximately 75% of retired Ohio state employees switched to TM. Hospitalizations for 3 high-volume conditions that usually require postacute rehabilitation were assessed. Data from the Medicare Provider Analysis and Review files were used to identify all hospitalizations in short-term acute care hospitals. Difference-in-difference regressions were used to estimate changes for retired Ohio state employees compared with other 2015 MA enrollees in Ohio and with Kentucky public retirees who were continuously offered a mandatory MA plan. Data analyses were performed from September 1, 2019, to November 30, 2023. Exposures Enrollment in Ohio state retiree health benefits in 2015, after which most members shifted to TM. Main Outcomes and Measures Received care in an inpatient rehabilitation facility, skilled nursing facility, or home health, or any postacute care; the occurrence of any hospital readmission; the number of days in the community during the 30 days after hospital discharge; and mortality. Results The study sample included 2373 hospitalizations for Ohio public retirees, 1651 hospitalizations for other Humana MA enrollees in Ohio, and 589 hospitalizations for public retirees in Kentucky. After the 2016 policy implementation, the percentage of hospitalizations covered by MA decreased by 70.1 (95% CI, −74.2 to −65.9) percentage points (pp), inpatient rehabilitation facility admissions increased by 9.7 (95% CI, 4.7 to 14.7) pp, use of only home health or skilled nursing facility care fell by 8.6 (95% CI, −14.6 to −2.6) pp, and days in the community fell by 1.6 (95% CI, −2.9 to −0.3) days for Ohio public retirees compared with other Humana MA enrollees in Ohio. There was no change in 30-day mortality or hospital readmissions; similar results were found by comparisons using Kentucky public retirees as a control group. Conclusions and Relevance The findings of this cohort study indicate that after a change in retiree health benefits, most Ohio public retirees shifted from MA to TM and received more intensive postacute care with no significant change in measured short-term postdischarge outcomes. Future work should consider additional measures of postacute functional status over a longer follow-up period. Introduction The share of Medicare beneficiaries enrolled in Medicare Advantage (MA) instead of traditional fee-for-service Medicare (TM) continues to grow, with the MA share increasing from 19% in 2007 to 51% in 2023.1 The US Centers for Medicare & Medicaid Services (CMS) pay MA plans a monthly capitated rate to cover nearly all health care expenses for plan enrollees, and plans keep as profits the portion of the payment not used for enrollees’ health care expenses. Plans are permitted to use tools such as prior authorization and a limited provider network to manage enrollees’ health care use.2 Proponents argue that these financial incentives and delivery tools for MA plans enable them to provide care more efficiently than TM. However, in reducing costs, MA plans may focus on maintaining short-term health outcomes while neglecting services that promote better long-term health and functioning. Postacute care (PAC) may contribute to better long-term functioning, but also imposes higher short-term costs, and thus may be provided differently by MA plans compared with TM. After a hospital stay, patients can receive rehabilitation services and skilled nursing care in an inpatient rehabilitation facility (IRF), a skilled nursing facility (SNF), or in their home from a home health agency (HH). Although there have not been large randomized clinical trials evaluating alternative settings for postacute rehabilitation services, observational research has found that patients admitted to IRFs after a hospitalization for stroke had better mobility and ability to perform self-care compared with patients admitted to SNFs.3 Other research found that patients admitted to IRFs had lower mortality (after stroke hospitalizations) and increased longer-term community residence (after hip fracture and stroke hospitalizations) compared with patients discharged to SNFs.4 Similarly, patients admitted to SNFs had lower readmissions than patients receiving HH, although with no difference in mortality or functional outcomes.5 However, IRF stays are substantially more expensive than SNF stays, which in turn are more expensive than HH episodes.5,6 A 2022 report from the US Department of Health and Human Services Office of the Inspector General found that MA plans had denied requests for IRF care that were deemed to meet criteria for medical necessity.6 Consistent with the report, prior cross-sectional research has found that MA enrollees were more likely than TM enrollees to be discharged to home without institutional postacute or HH after hospitalizations for joint replacement, stroke, and heart failure,7 and were less likely than TM enrollees to be admitted to IRFs across conditions.7,8 The prior cross-sectional studies found limited evidence of an adverse association between MA enrollment and postdischarge outcomes such as readmissions. However, MA enrollment is voluntary and MA enrollees tend to be healthier (ie, have lower mortality risk) than TM enrollees conditional on age, sex, and Medicaid enrollment.9 As a result, studies relating observed MA enrollment with patient outcomes may overstate MA’s ability to reduce costs without harming patient health. This study builds on prior work using changes in state retiree health benefits in Ohio as a natural experiment to estimate the association of MA enrollment with PAC use and postdischarge outcomes. Methods This study was reviewed and approved by the University of Minnesota Institutional Review Board. Informed consent was waived because the research involved minimal risk to participants. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. We investigated changes in PAC use and postdischarge outcomes among retired Ohio state employees (hereafter, public retirees) whose retiree health benefits changed from a mandatory sponsored MA plan for public retirees in 2015 to a subsidy for purchasing coverage through an MA plan or supplemental coverage for TM in 2016. In a 2015 benefits guide, the Ohio Public Employee Retirement System (OPERS) explained the change by noting that the OPERS-sponsored MA plan was more costly than the more comprehensive supplemental Medigap plans on the individual market and that per-retiree costs of providing the OPERS group plan were rising.10 Under the new OPERS retiree health benefit, public retirees received a monthly Health Reimbursement Account allowance of up to $337 that they could use to purchase Medigap, Part D, or MA coverage through a private Medicare exchange (the Medicare Connector) managed by a private contractor. In January 2015, all Medicare-eligible Ohio public retirees receiving health benefits were enrolled in a mandatory group MA plan managed by Humana, Inc (hereafter, other Humana MA enrollees). In 2016, when public retirees had a choice of supplemental TM or MA plans, only 25% chose to remain enrolled in MA (eResults in Supplement 1). The OPERS benefits guide describing the comprehensive benefits of supplemental TM Medigap plans may have persuaded some public retirees to switch to TM. We estimated intent-to-treat effects of this policy change using a difference-in-differences approach, comparing changes in outcomes for Ohio public retirees after the change in health benefits with comparison groups that were unaffected by the change. We focused on 2 distinct comparison groups that were likely to provide an accurate counterfactual for what would have happened to public retirees in the absence of the changes in health benefits. Comparison group 1 comprised Ohio enrollees in other Humana MA plans (ie, not the plan for Ohio public retirees) in January 2015, 98% of whom remained enrolled in MA in 2016 as well. Because public retirees may have different trends in health care use than other Medicare beneficiaries, for comparison group 2 we chose public retirees in Kentucky because they received retiree health benefits through a mandatory Humana MA plan in 2015 and 2016. Given that 75% of the treatment group in Ohio shifted from MA to TM, whereas no more than 2% of the comparison groups shifted from MA to TM, our intention-to-treat estimates may provide a conservative estimate of the association of MA enrollment with the stated study outcomes. Study Population Our analysis investigated hospital stays and 30-day postdischarge periods for the treatment group and the 2 comparison groups between 2015 and 2016. We focused on 3 high-volume conditions that require intensive rehabilitation after hospitalization: lower extremity joint replacement after a fracture; hip and femur procedures (after a fracture; in an academic tertiary hospital, the most common procedures were intramedullary nailing, dynamic hip screw, and open reduction internal fixation11); and stroke (only the first stroke observed per patient during the study period). For joint replacement, we included MS-DRG codes 469 and 470, with a principal diagnosis of fracture per the International Classification of Diseases, Ninth Revision (ICD-9) and 10 Revision (ICD-10) that are used by the CMS Comprehensive Joint Replacement program12; and for stroke, we included MS-DRG codes 64, 65, and 66. Medicare stipulates that 60% of IRF admissions must meet a set of conditions determined to require intensive rehabilitation; hip fracture and stroke are both included.13 Notably, these hospitalizations are unlikely to be elective and are not readily predictable as they occur after an acute event such as a fracture or a stroke. Therefore, it is unlikely that MA compared with TM enrollment will substantially affect the probability of hospitalization for these conditions, although we also investigated this empirically. We excluded hospital discharges occurring in December 2016 because we were not able to observe PAC use in 2017. Our analysis focused on index hospitalizations—admissions that did not occur within 30 days of another hospital discharge—and excluded hospitalizations during which the patient died. Data Sources We used the Medicare Master Beneficiary Summary File to identify retirees in Ohio with an MA plan or TM coverage, MA plan type and contract identifiers (for MA enrollees), state of residence, demographic and socioeconomic status information, and mortality. We identified the contract identifiers for public retirees using information from the Ohio Public Retirees Open Enrollment Guide for retired state employees, detailed in the eAppendix in Supplement 1.10,14 A challenge to comparing health care use between MA and TM enrollees is finding consistent data for both types of Medicare beneficiaries. We identified index hospitalizations using the Medicare Provider Analysis and Review (MedPAR) files, focusing on hospitals that received disproportionate share or medical education payments from CMS that are required to submit encounter claims for MA enrollees to receive full payment15,16; notably, this includes most short-term acute care hospitals.7 We identified hospital discharges for the included conditions based on the Medicare Severity Diagnosis-Related Group (MS-DRG) on the hospital claim.12 We identified SNF admissions and days using SNF claims for TM enrollees and the Minimum Data Set (MDS) assessments for MA enrollees (augmented with SNF claims, in the small number of cases where they were reported in MedPAR). We identified IRF stays from the Inpatient Rehabilitation Facility Patient Assessment Instrument, and HH episodes from the Home Health Outcome and Assessment Information Set (OASIS) data given that facilities must submit assessments for both MA and TM enrollees.17 For our primary approach for measuring hospital readmissions, we used MedPAR and identified all hospitalizations in short-term acute care hospitals (across conditions) occurring within 30 days of the index hospital discharge for which hospitals are required to submit information-only claims for MA enrollees. We created an alternative measure of readmissions, augmenting the MedPAR hospitalization data with discharge-level data from the Healthcare Effectiveness Data and Information Set (HEDIS), which is further described in the eAppendix in Supplement 1. Study Measures The outcome variables for the study analyses included measures of PAC use and patient outcomes within 30-days of hospital discharge. We focused on 3 binary categories indicating level of PAC use: patient received any IRF, with or without SNF and/or HH (category 1); SNF or HH, but no IRF (category 2); and no PAC, ie, no HH, SNF, or IRF (category 3). For category 2, we separately assessed whether the patient had received SNF (with or without HH) compared with receiving only HH. Patient outcome variables included whether patients were readmitted to a hospital for any condition within 30 days of discharge (constructed separately using solely MedPAR data, and using both MedPAR and HEDIS data); the number of days in the community during the 30-day postdischarge period (ie, alive and not in a hospital, nursing home, or institutional PAC setting); the number of days in an SNF, IRF, or nursing home; the number of days in a hospital; and whether death occurred during the 30 days postdischarge; and days deceased. Statistical Analyses Difference-in-differences regressions were used to estimate changes in PAC use and postdischarge outcomes after hospitalizations before and after the benefits policy change compared with each of the 2 comparison groups. Explanatory variables in the regression included the interaction effect of being an Ohio public retiree after the policy change in 2016 (giving the coefficient estimate of interest), an indicator variable for being an Ohio public retiree, year by quarter fixed effects, hospital fixed effects, and control variables, including age, sex, RTI (Research Triangle Institute) race and ethnicity code, MS-DRG code (ie, reason for a hospital admission), Medicaid eligibility, and fixed effects for the discharging hospital. We did not control for other comorbidities because of concerns about more intensive diagnosis coding in MA.18 We estimated separate models for each of the 2 comparison groups. Linear regressions were used for continuous variables and linear probability models were used for binary outcomes. Clustered standard errors were calculated at the treatment status by health service area level.19 Further details on the statistical analysis are available in the eAppendix in Supplement 1. In preliminary analyses, we estimated difference-in-differences regressions at the person-quarter level to assess whether the policy shifting Ohio public retirees to TM changed the probability of having hospital admissions for the 3 conditions in our defined cohort. We performed this initial analysis because inclusion in our main analyses required having a hospitalization for a set of conditions, which could introduce selection bias if MA enrollment affects the probability of hospital admission for these conditions. The eAppendix in Supplement 1 describes event study regressions that allowed for testing for differences in time trends in outcomes by treatment status before the policy implementation and assess dynamic estimated effects on outcomes postpolicy intervention. Intent-to-treat estimates included Ohio public retirees who shifted to TM but also a minority number of individuals who continued to be enrolled in MA. To understand the broader generalizability of these estimates, we compared the characteristics of the 2 groups of Ohio public retirees (those who in 2016 switched from mandatory MA plan to other MA plans vs those who switched to TM instead). As a placebo test, we estimated separate difference-in-difference regressions for Ohio public retirees who continued with the MA plan (vs those who switched to TM). In addition, we explored the presence of heterogeneous effects, estimating separate effects for patients with stroke or fracture, and for patients residing in metropolitan or nonmetropolitan counties.20 Statistical tests were 2-tailed and P < .05 were considered statistically significant. Data analyses were performed from September 1, 2019, to November 30, 2023, and final estimates were generated using Stata, version 18.0 MP-parallel edition (StataCorp). Results From January 1 to December 31, 2015, and from January 1 to November 1, 2016, there were 1217 and 1156 hospital discharges, respectively, for the 3 conditions (lower extremity joint replacement after a fracture, hip and femur procedures, and stroke) among Ohio public retirees compared with 840 and 811 for other Ohio Humana MA enrollees, and 285 and 304 for Kentucky public retirees (Table 1). The demographic characteristics of the Ohio public retirees in 2015 were similar to those of the comparison groups; eg, both Ohio and Kentucky, public retirees were more likely to be female. However, in Kentucky, a higher percentage of public retirees were White. The composition of hospitalized individuals did not change substantially among groups across the 2 years. Notably, we found no relative change in the probability of hospitalization for the conditions in the study sample for Ohio public retirees and either of the comparison groups (other Ohio Humana MA enrollees or Kentucky retirees), alleviating concerns about selection bias coming from conditioning the main analysis on having a hospitalization (eResults in Supplement 1). Descriptive Findings The adjusted rate of MA coverage for hospital stays (adjusting for the control variables) decreased for Ohio public retirees hospitalized for the 3 conditions, from nearly 100% in early 2015 to approximately 25% in 2016, whereas enrollees in other Ohio Humana MA plans in 2015 (comparison group 1) mostly continued their enrollment in MA in 2016 (Figure, A). When Ohio public retirees’ health benefits were provided through a mandatory Humana MA plan in 2015, inpatient rehabilitation use was similar to other Ohio Humana MA plans (<8% of discharges), but when most Ohio public retirees switched to TM in 2016, inpatient rehabilitation admissions increased to approximately 16% of hospital discharges, whereas other Ohio Humana MA plans’ IRF admission rates remained lower (Figure, B). The percentage of Ohio public retirees and other Ohio Humana MA enrollees receiving only HH or SNF was greater than 75% in 2015, but fell for Ohio public retirees in 2016 (Figure, C); the overall high rate of SNF admissions reflects that approximately half of the sample was comprised of patients with hip fracture , a condition that has a high rate of discharge to SNFs after hospitalization.21 Hospital readmissions were similar for Ohio public retirees and other Humana MA enrollees in both 2015 and 2016, suggesting that switching from MA to TM did not affect hospital readmissions (Figure, D). However, there was a decrease in the number of days Ohio public retirees spent in the community after hospital discharge after the switch from TM to MA compared with other Ohio MA enrollees (Figure, E). Event study results show that trends in each outcome were generally parallel between Ohio public retirees and other Ohio Humana MA enrollees before the policy change (supporting the use of other Ohio Humana MA enrollees as a comparison group; eResults in Supplement 1). By the fourth quarter of 2016, inpatient rehabilitation facility admissions had increased by 11.5 percentage points (pp) (95% CI, 5.5 to 17.8; P < .001) and receiving only HH or SNF fell by 9.8 pp (95% CI, −1.2 to −1.4; P = .02). Difference-in-Differences Results Table 2 displays difference-in-differences estimates for PAC and postdischarge patient outcomes. The first column displays the 2015 mean for Ohio public retirees, followed by separate difference-in-differences estimates for Ohio public retirees compared with other Ohio Humana MA enrollees (comparison group 1) and Ohio public retirees compared with Kentucky public retirees (comparison group 2). Compared with other Ohio Humana MA enrollees, the percentage of hospitalizations for Ohio public retirees covered by MA decreased by 70.1 (95% CI, −74.2 to −65.9) pp from 2015 to 2016 (P < .001). During the same period, relative to other Ohio Humana MA enrollees, inpatient rehabilitation facility admissions among Ohio public retirees increased by 9.7 (95% CI, 4.7 to 14.7; P < .001) pp and the percentage of Ohio public retirees receiving only HH or SNF fell by 8.6 (95% CI, −14.6 to −2.6; P = .006) pp; this was nominally driven by reductions in SNF rather than only HH use; however, the estimates were statistically insignificant. There was no change in the overall probability of using PAC. We found similar relative changes in PAC use comparing Ohio public retirees to Kentucky public retirees, although there was a nominally larger, but statistically insignificant, reduction in receiving no PAC, and the reduction in use of SNF or HH without IRF was also statistically insignificant. We assessed 2 measures of readmissions: the first included readmissions identified in MedPAR occurring in short-term acute care hospitals that are required to submit information-only claims to Medicare for MA enrollees. The second included all acute care and critical access hospital readmissions identified in MedPAR as well as hospital readmissions identified in HEDIS data (for MA enrollees). Despite the increased intensity of PAC use after Ohio public retirees switched from MA to TM, we found no relative change in hospital readmissions across readmission measures and comparison groups. In the 30 days after hospital discharge, the Medicare beneficiaries in the sample were in 1 of 4 mutually exclusive and exhaustive states: (1) in the community, (2) readmitted to hospital, (3) in a PAC facility or nursing home, or (4) deceased. We investigated the number of days-stay in each state for Ohio public retirees and the 2 comparison groups. We found statistically significant reductions in the number of days that Ohio public retirees resided in the community during the first 30 days after hospital discharge (−1.6 [95% CI, −2.9 to −0.3] and −2.5 [95% CI, −4.9 to −0.1]) days for comparison groups 1 and 2, respectively. The reduction in community days was nominally driven by increased days in PAC, but this was only significant when comparing Ohio public retirees with Kentucky public retirees (3.1; 95% CI, 0.9 to 5.3; P = .007) days. We also found no significant change in mortality after Ohio public retirees switched to TM. Our analysis used an intent-to-treat design, and not all Ohio public retirees switched to TM in 2016 (approximately 25% of hospitalized patients in our sample remained in MA). These 2 groups were similar in terms of demographic and clinical composition, implying the broader generalizability of the estimates across Ohio public retirees (eResults in Supplement 1). Changes in PAC use were driven entirely by the Ohio public retirees switching to TM (eResults in Supplement 1), ruling out that effects were driven by changes in plan design among public retirees electing to continue coverage with MA. We found nominally larger estimated effects on PAC use for patients with stroke rather than fractures patients, but the differences in the effects were statistically insignificant (eResults in Supplement 1). We found a similar pattern of results for metropolitan compared with nonmetropolitan counties, although there was nominal (but statistically insignificant) increase in receiving no PAC for nonmetropolitan counties (eResults in Supplement 1). Discussion When Ohio shifted public retiree health benefits from a mandatory MA plan in 2015 to subsidies for either a MA plan or supplemental coverage for TM, most retirees switched to TM. This natural experiment provided a unique opportunity to identify the association of MA with PAC use and outcomes for Medicare beneficiaries. We found that, under TM, Ohio public retirees were more likely to be discharged to a more intensive and expensive IRF and less likely to receive only SNF or HH. However, despite receiving more intensive PAC under TM, hospital readmissions and 30-day mortality for Ohio public retirees were unchanged. Because of the direct mechanical association with more days spent in PAC facilities, days in the community during the 30 days postdischarge were reduced under TM. The finding that Ohio public retirees were more likely to be discharged to an IRF under TM is consistent with the findings of prior cross-sectional studies comparing MA with TM, which found lower use of PAC overall in MA,7,8,22 shorter stays in SNFs with fewer therapy minutes,23 lower use of postacute HH,7,24 lower use of IRF,7,8 and evidence of substitution of SNF for IRF care after stroke and joint replacement hospitalizations.7,8 A key contribution of our research is showing that MA vs TM differences in IRF use reflect different approaches to providing PAC rather than patient-level selection into MA. However, an important unanswered question raised by this and previous studies is whether the reduced use of IRFs in MA results from case-by-case “active management” that tries to match each patient to the most appropriate type of PAC or from general restrictions—eg, through the exclusion of IRFs from plans’ networks—that can only be overcome with extensive effort, persistence, and clinical justification. Notably, the available benefits documentation for the sponsored MA plan in our study did not mention IRF services. Barnett et al25 previously noted that TM payment reforms, such as Accountable Care Organizations and bundled payment and MA plans generate savings by reducing the use of PAC, which may have adverse effects on patients and caregivers. Moreover, the concern with the lower use of IRF in MA is that beneficiaries who would benefit from the more intensive rehabilitation services may not be allowed access to these services. We found that when compared with MA, TM did not affect hospital readmissions or 30-day mortality for Ohio public retirees. However, long-term improvement in functioning, the main goal of rehabilitation, may occur even without changes in short-term outcomes such as hospital readmission and 30-day mortality. As noted earlier, prior studies of TM beneficiaries3,4 found that patients with hip fracture or stroke were more likely to be alive and residing in the community at 120 days after hospital discharge when they received rehabilitation care in IRFs compared with SNFs, and that patients admitted to IRFs had better mobility and ability to perform self-care activities than patients in SNFs. Other recent research using the US National Health and Aging Trends Study22 found that MA enrollees had less functional improvement during postacute care use. More causal evidence is needed on the effects of MA compared with those of TM for a broader set of functional outcomes over a longer study period. Limitations This analysis had limitations. First, hospital readmissions and community residence at 30 days after discharge do not fully capture postdischarge functional status. Future work should consider the longer-term effects of less-intensive PAC on beneficiaries’ functional status and on the well-being of caregivers. Second, a key unanswered question for future research is the mechanisms by which MA plans change PAC use, eg, whether this is done using prior authorization, more active discharge planning, or as previously suggested, narrower facility and clinician networks that largely exclude IRFs. Third, we selected conditions for which intensive rehabilitation is less discretionary after a hospitalization; the association of MA with PAC use may differ for other conditions requiring less rehabilitation. Conclusions This cohort study found that after a change in retiree health benefit policy, most Ohio public retirees shifted from MA to TM and received more intensive PAC with no significant change in the measured short-term postdischarge outcomes. Future work should consider measures of postacute functional status over a longer follow-up period. Back to top Article Information Accepted for Publication: December 13, 2023. Published: February 16, 2024. doi:10.1001/jamahealthforum.2023.5325 Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2024 Huckfeldt PJ et al. JAMA Health Forum. Corresponding Author: Peter J. Huckfeldt, PhD, Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE, MMC 729, Minneapolis, MN 55455 (huckfeld@umn.edu). Author Contributions: Dr Huckfeldt had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Huckfeldt, Shier, Escarce, Sood. Acquisition, analysis, or interpretation of data: Huckfeldt, Shier, Rabideau, Boese, Parsons, Sood. Drafting of the manuscript: Huckfeldt, Escarce. Critical review of the manuscript for important intellectual content: All authors. Statistical analysis: Huckfeldt, Shier, Boese. Obtained funding: Huckfeldt, Sood. Administrative, technical, or material support: Huckfeldt, Shier, Rabideau, Boese. Supervision: Huckfeldt, Escarce, Parsons, Sood. Conflict of Interest Disclosures: Dr Huckfeldt reported grants from the National Institute on Aging and the National Institute of Diabetes and Digestive and Kidney Diseases of the US National Institutes of Health, the Agency for Healthcare Research and Quality, and the Robert Wood Johnson Foundation, and contract funding from the US Centers for Medicare & Medicaid Services. Dr Boese reported funding from the US Centers for Medicare & Medicaid Services through NORC at the University of Chicago for evaluating the Next Generation Accountable Care Organization model and a grant from The Donaghue Foundation outside the submitted work. Dr Rabideau reports receiving funding through a training grant from the US National Institute of Mental Health outside the submitted work.Dr Sood reported being a visiting scholar at Amazon.com. No other disclosures were reported. Funding/Support: This research was supported by the US National Institute on Aging (grant Nos. R01AG071731, R01AG079216, and R01AG046838). Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Data Sharing Statement: See Supplement 2. References 1. Kaiser Family Foundation. Medicare Advantage in 2023: Enrollment Update and Key Trends. Accessed December 1, 2023. https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2023-enrollment-update-and-key-trends/ 2. Neuman P, Jacobson GA. Medicare Advantage checkup. N Engl J Med. 2018;379(22):2163-2172. doi:10.1056/NEJMhpr1804089PubMedGoogle ScholarCrossref 3. Hong I, Goodwin JS, Reistetter TA, et al. Comparison of functional status improvements among patients with stroke receiving postacute care in inpatient rehabilitation vs skilled nursing facilities. JAMA Netw Open. 2019;2(12):e1916646. doi:10.1001/jamanetworkopen.2019.16646 ArticlePubMedGoogle ScholarCrossref 4. Buntin MB, Colla CH, Deb P, Sood N, Escarce JJ. Medicare spending and outcomes after postacute care for stroke and hip fracture. Med Care. 2010;48(9):776-784. doi:10.1097/MLR.0b013e3181e359dfPubMedGoogle ScholarCrossref 5. Werner RM, Coe NB, Qi M, Konetzka RT. Patient outcomes after hospital discharge to home with home health care vs to a skilled nursing facility. JAMA Intern Med. 2019;179(5):617-623. doi:10.1001/jamainternmed.2018.7998 ArticlePubMedGoogle ScholarCrossref 6. US Department of Health and Human Services Office of Inspector General. Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care. Accessed June 8, 2023. https://oig.hhs.gov/oei/reports/OEI-09-18-00260.asp 7. Skopec L, Huckfeldt PJ, Wissoker D, et al. Home health and postacute care use in Medicare Advantage and traditional Medicare. Health Aff (Millwood). 2020;39(5):837-842. doi:10.1377/hlthaff.2019.00844PubMedGoogle ScholarCrossref 8. Huckfeldt PJ, Escarce JJ, Rabideau B, Karaca-Mandic P, Sood N. Less intense postacute care, better outcomes for enrollees in Medicare Advantage than those in fee-for-service. Health Aff (Millwood). 2017;36(1):91-100. doi:10.1377/hlthaff.2016.1027PubMedGoogle ScholarCrossref 9. Newhouse JP, Price M, McWilliams JM, Hsu J, Souza J, Landon BE. Adjusted mortality rates are lower for Medicare Advantage than traditional Medicare, but the rates converge over time. Health Aff (Millwood). 2019;38(4):554-560. doi:10.1377/hlthaff.2018.05390PubMedGoogle ScholarCrossref 10. Ohio Public Retirees Retirement System. 2015 OPERS HealthCare Medicare Guide. 2014. https://www.opers.org/ 11. Cooper KB, Mears SC, Siegel ER, Stambough JB, Bumpass DB, Cherney SM. The hip and femur fracture bundle: preliminary findings from a tertiary hospital. J Arthroplasty. 2022;37(8S):S761-S765. doi:10.1016/j.arth.2022.03.059PubMedGoogle ScholarCrossref 12. US Health and Human Services. CMS Comprehensive Joint Replacement program. https://www.hhs.gov/guidance/document/cjr-icd-9-and-icd-10-hip-fracture-diagnosis-codes 13. Medicare Payment Advisory Commission. Inpatient Rehabilitation Facilities Payment System. Published 2021. Accessed July 27, 2023. https://www.medpac.gov/wp-content/uploads/2021/11/medpac_payment_basics_21_irf_final_sec.pdf 14. Ohio Public Retirees Retirement System. Open Enrollment Guide 2016. Published 2015. Accessed December 1, 2023. https://www.opers.org/pubs-archive/healthcare/open/2016/2016openenrollmentguide.pdf 15. US Centers for Medicare & Medicaid Services. Capturing days on which Medicare beneficiaries are entitled to Medicare Advantage (MA) in the Medicare/Supplemental Security Income (SSI) fraction. Published 2007. Accessed July 27, 2023. https://www.hhs.gov/guidance/document/capturing-days-which-medicare-beneficiaries-are-entitled-medicare-advantage-ma 16. ResDAC. Identifying Medicare Managed Care Beneficiaries from the Master Beneficiary Summary or Denominator Files. Published 2021. Accessed July 28, 2023. https://resdac.org/articles/identifying-medicare-managed-care-beneficiaries-master-beneficiary-summary-or-denominator 17. US Centers for Medicare & Medicaid Services. Home Health Quality Reporting Program. Published 2023. Accessed November 30, 2023. https://www.cms.gov/medicare/quality/home-health 18. Geruso M, Layton T. Upcoding: evidence from Medicare on Squishy risk adjustment. J Polit Econ. 2020;12(3):984-1026. doi:10.1086/704756PubMedGoogle ScholarCrossref 19. US National Cancer Institute. Health Service Areas. Published 2008. Accessed December 1, 2023. https://seer.cancer.gov/seerstat/variables/countyattribs/hsa.html 20. US Department of Agriculture Economic Research Service. Rural-Urban Continuum Codes. Published 2023. Accessed November 30, 2023. https://www.ers.usda.gov/data-products/rural-urban-continuum-codes/ 21. Cupp MA, Beaudoin FL, Hayes KN, et al. Post-acute care setting after hip fracture hospitalization and subsequent opioid use in older adults. J Am Med Dir Assoc. 2023;24(7):971-977.e4. doi:10.1016/j.jamda.2023.03.012PubMedGoogle ScholarCrossref 22. Achola EM, Stevenson DG, Keohane LM. Postacute care services use and outcomes among traditional Medicare and Medicare Advantage beneficiaries. JAMA Health Forum. 2023;4(8):e232517. doi:10.1001/jamahealthforum.2023.2517 ArticlePubMedGoogle ScholarCrossref 23. Kumar A, Rahman M, Trivedi AN, Resnik L, Gozalo P, Mor V. Comparing post-acute rehabilitation use, length of stay, and outcomes experienced by Medicare fee-for-service and Medicare Advantage beneficiaries with hip fracture in the United States: a secondary analysis of administrative data. PLoS Med. 2018;15(6):e1002592. doi:10.1371/journal.pmed.1002592PubMedGoogle ScholarCrossref 24. Loomer L, Kosar CM, Meyers DJ, Thomas KS. Comparing receipt of prescribed post-acute home health care between Medicare Advantage and traditional Medicare beneficiaries: an observational study. J Gen Intern Med. 2021;36(8):2323-2331. doi:10.1007/s11606-020-06282-3PubMedGoogle ScholarCrossref 25. Barnett ML, Mehrotra A, Grabowski DC. Postacute care: the piggy bank for savings in alternative payment models? 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