BACKGROUND: Stroke affects more than 500,000 older persons each year in the United States, but no studies have compared older stroke patients in Medicare health maintenance organizations (HMOs) and fee-for-service (FFS) after recent changes in FFS reimbursement. OBJECTIVES: We sought to compare utilization and outcomes after stroke in Medicare HMO and FFS. DESIGN: We reviewed administrative data in 11 regions from Medicare and a large national health plan. SUBJECTS: We studied Medicare beneficiaries 65 years and older discharged with ischemic stroke during 1998-2000, ie, 4816 HMO patients and a random sample of 4187 FFS patients from 422 hospitals. MEASURES: We measured survival, rehospitalization, length of stay, discharge destination, and warfarin use. RESULTS: Overall, HMO patients were younger, male, non-Caucasian, and had fewer comorbid conditions. When compared with FFS patients, HMO patients were more likely to be rehospitalized within 30 days for a primary diagnosis of ischemic stroke (Adjusted Hazard Ratio = 1.45, 95% Confidence Interval [CI] 1.14-1.83) or ill-defined conditions (eg, rehabilitation services) (2.87, 95% CI 1.85-4.46) and less likely to be rehospitalized for fluid and electrolyte disorders (0.54, 95% CI 0.34-0.87) or circulatory/respiratory problems (0.77, 95% CI 0.60-0.98). There were no consistent differences in 30-day mortality or in 1-year rehospitalization or mortality for 30-day survivors. HMO patients also were much less likely to be discharged to rehabilitation facilities, slightly less likely to be discharged to skilled nursing facilities and to have a shorter length of stay, and did not differ in the use of home care services or warfarin use when compared with FFS patients. CONCLUSIONS: Traditional measures of quality such as 30-day rehospitalization may not be valid when comparing HMO and FFS patients if differences might reflect an alternative service mix. Utilization of post-acute care for FFS patients appears similar to HMO patients except for discharge to rehabilitation facilities.
BACKGROUND:Stroke affects more than 500,000 older persons each year in the United States, but no studies have compared older strokepatients in Medicare health maintenance organizations (HMOs) and fee-for-service (FFS) after recent changes in FFS reimbursement. OBJECTIVES: We sought to compare utilization and outcomes after stroke in Medicare HMO and FFS. DESIGN: We reviewed administrative data in 11 regions from Medicare and a large national health plan. SUBJECTS: We studied Medicare beneficiaries 65 years and older discharged with ischemic stroke during 1998-2000, ie, 4816 HMO patients and a random sample of 4187 FFS patients from 422 hospitals. MEASURES: We measured survival, rehospitalization, length of stay, discharge destination, and warfarin use. RESULTS: Overall, HMO patients were younger, male, non-Caucasian, and had fewer comorbid conditions. When compared with FFS patients, HMO patients were more likely to be rehospitalized within 30 days for a primary diagnosis of ischemic stroke (Adjusted Hazard Ratio = 1.45, 95% Confidence Interval [CI] 1.14-1.83) or ill-defined conditions (eg, rehabilitation services) (2.87, 95% CI 1.85-4.46) and less likely to be rehospitalized for fluid and electrolyte disorders (0.54, 95% CI 0.34-0.87) or circulatory/respiratory problems (0.77, 95% CI 0.60-0.98). There were no consistent differences in 30-day mortality or in 1-year rehospitalization or mortality for 30-day survivors. HMO patients also were much less likely to be discharged to rehabilitation facilities, slightly less likely to be discharged to skilled nursing facilities and to have a shorter length of stay, and did not differ in the use of home care services or warfarin use when compared with FFS patients. CONCLUSIONS: Traditional measures of quality such as 30-day rehospitalization may not be valid when comparing HMO and FFS patients if differences might reflect an alternative service mix. Utilization of post-acute care for FFS patients appears similar to HMO patients except for discharge to rehabilitation facilities.
Authors: Manoj K Mittal; Alejandro A Rabinstein; Jay Mandrekar; Robert D Brown; Kelly D Flemming Journal: Int J Neurosci Date: 2016-07-14 Impact factor: 2.292
Authors: Mary Stuart; Donato Papini; Francesco Benvenuti; Marco Nerattini; Enrico Roccato; Velio Macellari; Steven Stanhope; Richard Macko; Michael Weinrich Journal: Disabil Health J Date: 2010-10 Impact factor: 2.554
Authors: Judith H Lichtman; Erica C Leifheit-Limson; Sara B Jones; Emi Watanabe; Susannah M Bernheim; Michael S Phipps; Kanchana R Bhat; Shantal V Savage; Larry B Goldstein Journal: Stroke Date: 2010-10-07 Impact factor: 7.914
Authors: Amy J H Kind; Maureen A Smith; Jinn-Ing Liou; Nancy Pandhi; Jennifer R Frytak; Michael D Finch Journal: Arch Phys Med Rehabil Date: 2010-02 Impact factor: 3.966
Authors: Amy J H Kind; Maureen A Smith; Jinn-Ing Liou; Nancy Pandhi; Jennifer R Frytak; Michael D Finch Journal: J Am Geriatr Soc Date: 2008-04-18 Impact factor: 5.562
Authors: Corey R Fehnel; Yoojin Lee; Linda C Wendell; Bradford B Thompson; N Stevenson Potter; Vincent Mor Journal: J Am Heart Assoc Date: 2015-09-22 Impact factor: 5.501