Medicare Hospital Stays: Comparisons Between the Fee-for-Service Plan and Alternative Plans, 2006. Statistical Brief No. 66

摘要

More than 37 percent of hospital discharges in 2006 were beneficiaries of Medicare, who accounted for 47 percent of total hospital costs. The proportion of Medicare beneficiaries enrolled in plans that are alternative to the mainstream fee-for-service (FFS) plan grew from 10 percent in 1995 to 20 percent in 2007 according to the Congressional Budget Office. Most of these alternative plans are part of the Medicare Advantage program that pays plans a capitated fee per enrollee per month. The Medicare program does not collect detailed hospital discharge summaries for this important subset of patients. Many differences exist between alternative plans and the mainstream FFS plan that may result in differing hospital utilization patterns. First, the alternative plans can selectively negotiate with hospitals and physicians, adopt policies to limit particular services, and offer additional services, such as preventative care services, care management programs, and prescription drug coverage. Second, due to differing enrollment distributions, alternative plans may not attract a representative cross-section of mainstream Medicare FFS enrollees. Also, the alternative plans cannot insist upon using payment rates and quality improvement incentives employed by the mainstream Medicare FFS program. The purpose of this Statistical Brief is to describe basic differences in hospital stays between these two segments of Medicare hospital discharges. Only elderly Medicare beneficiaries (65 years and older) are included. Differences in patient characteristics, as well as utilization characteristics such as severity of illness, discharge status, and resource use per case are described. Moreover, information on principal reasons for admission, commonly performed procedures, and potentially avoidable hospital stays is presented. Data are drawn from 13 states that distinguish Medicare FFS plans versus alternative Medicare plans. These state databases contain about 38 percent of all elderly Medicare discharges in the country.