Black patients enrolled in both Medicare fee-for-service and Medicare Advantage are at greater risk for hospital readmissions after surgery than white patients who underwent the same procedures, according to a study published in Health Affairs.
Researchers found black Medicare patients were 33 percent more likely than their white counterparts to be readmitted to a hospital within 30 days of discharge. The disparity was nearly twice as large within Medicare Advantage — black MA patients were 64 percent more likely than white patients to be readmitted within 30 days of discharge post-surgery. The overall rates of 30-day readmission for Medicare and MA enrollees were 13.2 percent and 13.1 percent, respectively.
Though the data does not indicate why this disparity exists, the researchers identified several potential factors. Minority patients may receive lower quality surgical care in the hospital or they may be more likely to seek care at hospitals with lower quality care. They may also have poor transitional care post-discharge or lack access to rehabilitation services or community support, for example.
The study authors call for more research into why managed care in particular seems to be leaving black patients behind. Managed care plans like Medicare Advantage can be too restrictive in terms of provider networks and "gatekeeping policies," but they do offer enhanced education, preventive care and support, the authors wrote.
"Thus, our findings provide empirical evidence that these contrasting managed care mechanisms may collectively help reduce 30-day readmissions for white Medicare Advantage patients but work in the opposite way for black Medicare Advantage patients relative to their traditional Medicare counterparts — which leads to increased racial disparity among Medicare Advantage patients," the authors wrote.
The study was based on data from the New York State Inpatient Database from January through November 2013. Researchers examined data for more than 13,700 Medicare patients and 6,600 Medicare Advantage patients undergoing six selected surgeries in 2013.
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