Although the association of Medicare Advantage (MA) with low-value care among hospitalized patients was unknown, it is caring for a growing share of traditional Medicare (TM) patients. For a study, researchers sought to determine if invasive mechanical ventilation (IMV) use or mortality differed between hospitalized patients with advanced dementia (AD) who were enrolled in MA vs. TM and the impact of hospital MA concentration.
A retrospective cohort of hospitalized Medicare patients (n=147,153) aged 66 with AD who had a hospitalization with an evaluation conducted during a nursing home stay 120 days before that hospitalization indicating AD and significant cognitive/functional impairment from 2016 to 2017. At hospitalization, MA enrollment was identified; IMV usage and 30- and 365-day mortality were determined using Medicare data. Multivariable logistic regression models with hospital clustering were utilized.
Among hospitalized Medicare patients with Alzheimer’s disease, 27,253 (19%) were enrolled in MA, the mean age was 84 (95% CI: 83.9–84.0), and 92,736 (63%) were female. Enrollment in MA was linked with higher IMV usage (AOR=1.11, 95% CI: 1.04–1.18), 30-day (AHR=1.09, 95% CI: 1.05–1.12), and 365-day mortality (AHR=1.12, 95% CI: 1.08–1.16) compared to TM. However, the use of IMV was not affected by the concentration of MA at the hospital level.
Although MA may minimize hospitalizations, once admitted, individuals with AD engaged in MA have greater rates of IMV usage and poorer 30- and 365-day mortality than TM patients. Higher MA concentrations in hospitals did not affect IMV use.