Maricruz Rivera-Hernandez1, Amilcar Matos-Moreno2, Nasim B Ferdows3, Amit Kumar4. 1. Center for Gerontology and Healthcare Research at Brown University School of Public Health, Providence, RI, USA. Electronic address: maricruz_rivera-Hernandez@brown.edu. 2. Center for Social epidemiology and Population Health, University of Michigan, Ann Arbor, MI, USA. 3. Department of Health Administration and Policy, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. 4. Department of Physical Therapy at Northern Arizona University, Flagstaff, AZ, USA.
Abstract
OBJECTIVES: The purpose of the study is to contribute to the literature regarding post-acute nursing home utilization and quality indicators among Medicare beneficiaries in Puerto Rico compared with the US mainland. DESIGN: Medicare data from 2015 to 2017 was used to identify new discharges to skilled nursing facilities (SNFs) using the Minimum Data Set and the Medicare Provider Analysis and Review. SETTING AND PARTICIPANTS: Post-acute care patients admitted to SNFs in Puerto Rico and the United States. METHODS: Our final cohort included 4,732,222 beneficiaries from Puerto Rico and the United States enrolled in Medicare fee-for-service or Medicare Advantage programs admitted to an SNF (N = 15,197) following an acute hospital stay. We compared demographic, clinical, and facility-level characteristics among patients in Puerto Rico and the United States. We also described 2 quality indicators among these groups: (1) 30-day rehospitalization rates and (2) successful discharge from the facility to the community. RESULTS: Medicare patients in Puerto Rico were physically and cognitively healthier than patients in the United States. Puerto Ricans were also more likely to be admitted to lower quality nursing homes than US patients (2.5 vs 3.4). Finally, Puerto Ricans had higher rates of successful discharge to the community [17.6, 95% confidence interval (CI) 13.0-22.3], but higher 30-day rehospitalization rates compared with US patients (11.2, 95% CI 6.2-16.3). These differences were consistent even when comparing these quality outcomes among Puerto Ricans to US Hispanics only. CONCLUSIONS AND IMPLICATIONS: SNFs in the United States and Puerto Rico are now receiving financial penalties for high readmission rates. Currently, Medicare does not measure readmission rates for Medicare Advantage patients-even though some states, including Puerto Rico, have a high proportion of Medicare Advantage beneficiaries. As Medicare Advantage enrollment continues to increase, our results highlight the importance of measuring performance among Medicare Advantage patients and assessing disparities in quality of post-acute care among patients in Puerto Rico and the United States.
OBJECTIVES: The purpose of the study is to contribute to the literature regarding post-acute nursing home utilization and quality indicators among Medicare beneficiaries in Puerto Rico compared with the US mainland. DESIGN: Medicare data from 2015 to 2017 was used to identify new discharges to skilled nursing facilities (SNFs) using the Minimum Data Set and the Medicare Provider Analysis and Review. SETTING AND PARTICIPANTS: Post-acute care patients admitted to SNFs in Puerto Rico and the United States. METHODS: Our final cohort included 4,732,222 beneficiaries from Puerto Rico and the United States enrolled in Medicare fee-for-service or Medicare Advantage programs admitted to an SNF (N = 15,197) following an acute hospital stay. We compared demographic, clinical, and facility-level characteristics among patients in Puerto Rico and the United States. We also described 2 quality indicators among these groups: (1) 30-day rehospitalization rates and (2) successful discharge from the facility to the community. RESULTS: Medicare patients in Puerto Rico were physically and cognitively healthier than patients in the United States. Puerto Ricans were also more likely to be admitted to lower quality nursing homes than US patients (2.5 vs 3.4). Finally, Puerto Ricans had higher rates of successful discharge to the community [17.6, 95% confidence interval (CI) 13.0-22.3], but higher 30-day rehospitalization rates compared with US patients (11.2, 95% CI 6.2-16.3). These differences were consistent even when comparing these quality outcomes among Puerto Ricans to US Hispanics only. CONCLUSIONS AND IMPLICATIONS: SNFs in the United States and Puerto Rico are now receiving financial penalties for high readmission rates. Currently, Medicare does not measure readmission rates for Medicare Advantage patients-even though some states, including Puerto Rico, have a high proportion of Medicare Advantage beneficiaries. As Medicare Advantage enrollment continues to increase, our results highlight the importance of measuring performance among Medicare Advantage patients and assessing disparities in quality of post-acute care among patients in Puerto Rico and the United States.
Keywords:
Medicare Advantage beneficiaries; Medicare beneficiaries in Puerto Rico; post-ace care among Medicare Advantage beneficiaries; post-acute care in Puerto Rico
Authors: Orestis A Panagiotou; Amit Kumar; Roee Gutman; Laura M Keohane; Maricruz Rivera-Hernandez; Momotazur Rahman; Pedro L Gozalo; Vincent Mor; Amal N Trivedi Journal: Ann Intern Med Date: 2019-06-25 Impact factor: 25.391
Authors: Marcella Nunez-Smith; Elizabeth H Bradley; Jeph Herrin; Calie Santana; Leslie A Curry; Sharon-Lise T Normand; Harlan M Krumholz Journal: Arch Intern Med Date: 2011-06-27
Authors: Amílcar Matos-Moreno; Ashton M Verdery; Carlos F Mendes de Leon; Vivianna M De Jesús-Monge; Alexis R Santos-Lozada Journal: Gerontologist Date: 2022-08-12