Medicare Advantage sees fewer avoidable hospitalizations than original Medicare

Healthcare Finance News February 28, 2023
Jeff Lagasse

Apparent differences in potentially avoidable hospitalizations among MA plans may be explained by shifting inpatient care to other settings.

Medicare Advantage had fewer avoidable hospitalizations for ambulatory care−sensitive conditions (ACSCs) when compared to traditional Medicare, but were more likely to have observation stays and emergency department direct discharges for the same conditions, according to findings published in the Journal of the American Medical Association.

These findings raise the possibility of a “shifting effect,” authors said, whereby Medicare Advantage patients are more likely than traditional Medicare patients to be treated under observation status or in the ED instead of being admitted to the hospital.

Combining the number of hospitalizations, observation stays and ED direct discharges, Medicare Advantage patients were more likely...

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