• Vivek T Kulkarni, Sachin J Shah, Susannah M Bernheim, Yongfei Wang, Sharon-Lise T Normand, Lein F Han, Michael T Rapp, Elizabeth E Drye, and Harlan M Krumholz.
• Yale University School of Medicine, New Haven, CT 06510, USA.
• Med Care. 2012 May 1;50(5):406-9.

BackgroundRisk-standardized measures of hospital outcomes reported by the Centers for Medicare and Medicaid Services include Medicare fee-for-service (FFS) patients and exclude Medicare Advantage (MA) patients due to data availability. MA penetration varies greatly nationwide and seems to be associated with increased FFS population risk. Whether variation in MA penetration affects the performance on the Centers for Medicare and Medicaid Service measures is unknown.ObjectiveTo determine whether the MA penetration rate is associated with outcomes measures based on FFS patients.Research DesignIn this retrospective study, 2008 MA penetration was estimated at the Hospital Referral Region (HRR) level. Risk-standardized mortality rates and risk-standardized readmission rates for heart failure, acute myocardial infarction, and pneumonia from 2006 to 2008 were estimated among HRRs, along with several markers of FFS population risk. Weighted linear regression was used to test the association between each of these variables and MA penetration among HRRs.ResultsAmong 304 HRRs, MA penetration varied greatly (median, 17.0%; range, 2.1%-56.6%). Although MA penetration was significantly (P<0.05) associated with 5 of the 6 markers of FFS population risk, MA penetration was insignificantly (P≥0.05) associated with 5 of 6 hospital outcome measures.ConclusionRisk-standardized mortality rates and risk-standardized readmission rates for heart failure, acute myocardial infarction, and pneumonia do not seem to differ systematically with MA penetration, lending support to the widespread use of these measures even in areas of high MA penetration.

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