Medicare-Covered Services Near the End of Life in Medicare Advantage vs Traditional Medicare

Topic: Risk, prevention and care in population studies

Receipt of potentially burdensome hospitalizations and treatments; receipt of postdischarge home and facility care. The study included 659 135 TM enrollees (mean [SD] age at death, 83.3 [9.0] years, 54% female, 15.1% non-White, 55% with 1 or more life-limiting condition) and 360 430 MA enrollees (mean [SD] age at death 82.5 [8.7] years, 53% female, 19.3% non-White, 49% with 1 or more life-limiting condition). After regression adjustment, MA enrollees were less likely to receive potentially burdensome treatments (-1.6 percentage points (pp); 95% CI, -2.1 to -1.1) and less likely to die in a hospital (-3.3 pp; 95% CI, -4.0 to -2.7) compared with TM. However, when hospitalized, MA enrollees were more likely to die in the hospital (adjusted difference, 1.3 pp; 95% CI, 1.1-1.5) and less likely to be transferred to rehabilitative or skilled nursing facilities (-5.2 pp; 95% CI, -5.7 to -4.6). Higher rates of home health and home hospice among those discharged home offset half of the decline in facility use. Results were unchanged in the life-limiting conditions sample. MA enrollment was associated with lower rates of potentially burdensome and facility-based care near the EOL. Greater use of home-based care may improve quality of care but may also leave patients without adequate assistance after hospitalization.

Key findings

• Receipt of potentially burdensome hospitalizations and treatments; receipt of postdischarge home and facility care.
• The study included 659 135 TM enrollees (mean [SD] age at death, 83.3 [9.0] years, 54% female, 15.1% non-White, 55% with 1 or more life-limiting condition) and 360 430 MA enrollees (mean [SD] age at death 82.5 [8.7] years, 53% female, 19.3% non-White, 49% with 1 or more life-limiting condition).
• After regression adjustment, MA enrollees were less likely to receive potentially burdensome treatments (-1.6 percentage points (pp); 95% CI, -2.1 to -1.1) and less likely to die in a hospital (-3.3 pp; 95% CI, -4.0 to -2.7) compared with TM.
• However, when hospitalized, MA enrollees were more likely to die in the hospital (adjusted difference, 1.3 pp; 95% CI, 1.1-1.5) and less likely to be transferred to rehabilitative or skilled nursing facilities (-5.2 pp; 95% CI, -5.7 to -4.6).
• Higher rates of home health and home hospice among those discharged home offset half of the decline in facility use.

Why it matters

This study found that Medicare Advantage enrollees were less likely to receive potentially burdensome treatments and less likely to die in a hospital than traditional Medicare enrollees, but when hospitalized they were more likely to die in the hospital and less likely to be transferred to rehabilitative or skilled nursing facilities. Greater use of home-based care may improve quality of care but may also leave patients without adequate assistance after hospitalization.

Study details

• Participants659
• Effect size15.1%; 19.3%
• Evidence strengthLow

Read the original

• DOI: 10.1001/jamahealthforum.2024.1777
• PubMed: 39028655
• Original source →
• Free full text: JAMA Health Forum →

Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).

@article{nicholas2024-39028655,
  author  = {Nicholas, Lauren Hersch and Fischer, Stacy M. and Arbaje, Alicia I. and Perraillon, Marcelo Coca and Jones, Christine DeLong and Polsky, Daniel E.},
  title   = {{Medicare-Covered Services Near the End of Life in Medicare Advantage vs Traditional Medicare}},
  journal = {JAMA Health Forum},
  year    = {2024},
  doi     = {10.1001/jamahealthforum.2024.1777},
  pmid    = {39028655},
  url     = {https://doi.org/10.1001/jamahealthforum.2024.1777}
}

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