Chen Amanda C, Spertus Daniel, Fu Christina X, Sterling Madeline R, Grabowski David C
Department of Health Care Policy, Harvard Medical School, Boston, MA.
Harvard Graduate School of Arts and Sciences, Cambridge, MA.
Med Care. 2025 Jul 1;63(7):487-494. doi: 10.1097/MLR.0000000000002150. Epub 2025 Apr 29.
Because Traditional Medicare (TM) and Medicare Advantage (MA) have different reimbursement structures and incentives, it is important to understand differences in home health agency (HHA) use by payer type.
To quantify differences in care patterns and outcomes between TM and MA HHA users.
Medicare HHA claims were used to identify postacute HHA episodes among US adults aged 65 and older enrolled in MA or TM (2015-2019). Adjusted regression models with and without HHA fixed effects assessed whether TM and MA beneficiaries are treated differently within an HHA.
We examined process (timely initiation of care, receipt of a skilled nursing visit, and length of stay) and quality measures (hospital readmission and healthy days at home).
The study included 4,029,527 beneficiaries (3,034,452 TM and 995,075 MA). We identified large differences in the share of beneficiaries experiencing timely initiation of care (81.4% TM vs. 77.4% MA) and receipt of skilled nursing visits (86.8% TM vs. 81.9% MA). After including HHA fixed effects in the regression model, MA beneficiaries were 2.1 percentage points (pp) less likely to experience timely initiation of care and were 3.1 pp less likely to receive a skilled nursing visit (and 8.9 pp less likely to receive any type of skilled visit) within 2 days of starting HHA care compared with TM beneficiaries ( P <0.001).
Our findings suggest differential treatment between MA and TM beneficiaries within the same HHA. Further research is needed to understand the mechanisms driving these within-agency differences.
由于传统医疗保险（TM）和医疗保险优势计划（MA）具有不同的报销结构和激励措施，了解不同支付方类型的家庭健康机构（HHA）使用差异很重要。
量化TM和MA的HHA使用者在护理模式和结局方面的差异。
利用医疗保险HHA索赔数据，确定2015 - 2019年参保MA或TM的65岁及以上美国成年人中的急性后期HHA发作情况。采用有和没有HHA固定效应的调整回归模型，评估TM和MA受益人在HHA内是否受到不同对待。
我们检查了过程指标（护理的及时启动、接受专业护理访视以及住院时间）和质量指标（医院再入院率和在家健康天数）。
该研究纳入了4,029,527名受益人（3,034,452名TM受益人和995,075名MA受益人）。我们发现，在护理及时启动的受益人比例（TM为81.4%，MA为77.4%）和接受专业护理访视的比例（TM为86.8%，MA为81.9%）方面存在很大差异。在回归模型中纳入HHA固定效应后，与TM受益人相比，MA受益人在开始HHA护理后2天内护理及时启动的可能性降低了2.1个百分点（pp），接受专业护理访视的可能性降低了3.1个百分点（接受任何类型专业访视的可能性降低了8.9个百分点）（P<0.001）。
我们的研究结果表明，同一HHA内MA和TM受益人受到不同对待。需要进一步研究以了解导致这些机构内部差异的机制。
