30-day mortality from acute MI no longer varies by Medicare plan type
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In Medicare beneficiaries hospitalized for acute MI, 30-day mortality rates did not vary by Medicare plan type by 2018, researchers reported in JAMA.
In 2009, enrollment in Medicare Advantage was associated with slightly lower 30-day mortality rates after hospitalization for acute MI compared with enrollment in traditional Medicare, according to the researchers.
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Bruce E. Landon, MD, MBA, professor of health care policy at Harvard Medical School and professor of medicine and practicing internist at Beth Israel Deaconess Medical Center, and colleagues conducted a retrospective analysis of Medicare administrative data to determine whether 30-day mortality rates and other outcomes varied by Medicare plan enrollment.
The cohort included 2,227,502 patients hospitalized for acute MI (557,309 with STEMI, the rest with non-STEMI) between 2009 and 2018. The mean age ranged from 76.9 years for Medicare Advantage patients with STEMI to 79.3 years for traditional Medicare patients with non-STEMI. Approximately 42% were women.
30-day mortality rates
In 2009, enrollment in Medicare Advantage, compared with traditional Medicare, was associated with lower rates of 30-day mortality in the cohort (STEMI: 19.1% vs. 20.6%; difference, –1.5 percentage points; 95% CI, –2.2 to –0.7; non-STEMI: 12% vs. 12.5%; difference, –0.5 percentage points; 95% CI, –0.9 to –0.1), according to the researchers.
However, the difference disappeared by 2018 (STEMI: Medicare Advantage, 17.7%; traditional Medicare, 17.8%; difference, zero percentage points; 95% CI, –0.7 to 0.6; non-STEMI: Medicare Advantage, 10.9%; traditional Medicare, 11.1%; difference, –0.2 percentage points; 95% CI, –0.4 to 0.1), Landon and colleagues found.
“The results showed that mortality differences in the earlier years were diminished but not eliminated after controlling for patient comorbidities and did not change appreciably after including hospital fixed effects,” Landon and colleagues wrote. “This suggests that some of the differences in earlier outcomes likely were explained by unmeasured residual differences in health status but not by Medicare Advantage patients being treated at different sets of hospitals.”
There was also no difference between the groups in standardized 90-day revascularization rates by 2018, according to the researchers.
Rates of guideline-recommended medication prescriptions tended to be higher in the Medicare Advantage group than the traditional Medicare group, though the gap had often narrowed by 2018 compared with 2009, the researchers wrote. For example, in the STEMI population in 2018, the rate of statin prescription was 91.7% in the Medicare Advantage group and 89% in the traditional Medicare group (difference, 2.7 percentage points; 95% CI, 1.2-4.2), whereas in 2009, the rates were 82.6% in the Medicare Advantage group and 76.3% in the traditional Medicare group.
‘A less resource-intensive way’
Compared with the traditional Medicare group, the Medicare Advantage group was less likely to be admitted to an ICU and more likely to be discharged home instead of to a post-acute facility, Landon and colleagues wrote.
Adjusted 30-day readmission rates were lower in the Medicare Advantage group than in the traditional Medicare group (2009 STEMI population: 13.8% vs. 15.2%; difference, –1.3 percentage points; 95% CI, –2 to –0.6; 2018 STEMI population: 11.2% vs. 11.9%; difference, –0.6 percentage points; 95% CI, –1.5 to 0), according to the researchers.
“Medicare Advantage patients were treated in a less resource-intensive way when presenting with either type of MI,” Landon and colleagues wrote. “These differences likely amount to substantial savings accruing to Medicare Advantage plans for care that is largely similar to that delivered in traditional Medicare.”
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