Affiliation:
1. Division of Geriatric Medicine, Department of Medicine University of Colorado Anschutz Medical Campus Aurora Colorado USA
2. Division of Hospital Medicine, Department of Medicine University of Colorado Anschutz Medical Campus Aurora Colorado USA
3. Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai New York New York USA
4. Department of Economics University of Colorado Denver Denver Colorado USA
5. Division of Geriatrics, Department of Medicine University of California San Francisco California USA
Abstract
AbstractBackgroundFinancial incentives in capitated Medicare Advantage (MA) plans may lead to inadequate rehabilitation. We therefore investigated if MA enrollees had worse long‐term physical performance and functional outcomes after rehabilitation.MethodsWe conducted a retrospective cohort study of Medicare beneficiaries in the nationally representative National Health and Aging Trends Study. We compared MA and fee‐for‐service (FFS) beneficiaries reporting rehabilitation between 2014 and 2017 by change in (1) Short Physical Performance Battery (SPPB) and (2) NHATS‐derived Functional Independence Measure (FIM) from the previous year, using t‐tests incorporating inverse‐probability weighting and complex survey design. Secondary outcomes were self‐reported: (1) improved function during rehabilitation, (2) worse function since rehabilitation ended, (3) meeting rehabilitation goals, and (4) meeting insurance limits.ResultsAmong 738 MA and 1488 FFS participants, weighted mean age was 76 years (SD 7.0), 59% were female, and 9% had probable dementia. MA beneficiaries were more likely to be Black (9% vs. 6%) or Hispanic/other race (15% vs. 10%), be on Medicaid (14% vs. 10%), have lower income (median $35,000 vs. $48,000), and receive <1 month of rehabilitation (30% vs. 23%). MA beneficiaries had a similar decline in SPPB (−0.46 [SD 1.8] vs. −0.21 [SD 2.7], p‐value 0.069) and adapted FIM (−1.05 [SD 3.7] vs. −1.13 [SD 5.45], p‐value 0.764) compared to FFS. MA beneficiaries were less likely to report improved function during rehabilitation (61% [95% CI 56–67] vs. 70% [95% CI 67–74], p‐value 0.006). Other outcomes and analyses restricted to inpatient rehabilitation participants were non‐significant.Conclusions and RelevanceMA enrollment was associated with lower likelihood of self‐reported functional improvement during rehabilitation but no clinically or statistically significant differences in annual changes of physical performance or function. As MA expands, future studies must monitor implications on rehabilitation coverage and older adults' independence.
Funder
National Institute on Aging