Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 16;2(7):qxae089.
doi: 10.1093/haschl/qxae089. eCollection 2024 Jul.

Regional variation in length of stay for stroke inpatient rehabilitation in traditional Medicare and Medicare Advantage

Dian Luo  1 , Mariétou H Ouayogodé  1   2 , John Mullahy  1   2 , Ying Jessica Cao  1   2   3
Affiliations

Regional variation in length of stay for stroke inpatient rehabilitation in traditional Medicare and Medicare Advantage

Dian Luo et al. Health Aff Sch. .

Abstract

Regional variation in health care use threatens efficient and equitable resource allocation. Within the Medicare program, variation in care delivery may differ between centrally administered traditional Medicare (TM) and privately managed Medicare Advantage (MA) plans, which rely on different strategies to control care utilization. As MA enrollment grows, it is particularly important for program design and long-term health care equity to understand regional variation between TM and MA plans. This study examined regional variation in length of stay (LOS) for stroke inpatient rehabilitation between TM and MA plans in 2019 and how that changed in 2020, the first year of the COVID-19 pandemic. Results showed that MA plans had larger across-region variations than TM (SD = 0.26 vs 0.24 days; 11% relative difference). In 2020, across-region variation for MA further increased, but the trend for TM stayed relatively stable. Market competition among all inpatient rehabilitation facilities (IRFs) within a region was associated with a moderate increase in within-region variation of LOS (elasticity = 0.46). Policies reducing administrative variation across MA plans or increasing regional market competition among IRFs can mitigate regional variation in health care use.

Keywords: Medicare Advantage; inpatient rehabilitation; regional variation; traditional Medicare.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest Please see ICMJE form(s) for author conflicts of interest. These have been provided as supplementary materials.

Figures

Figure 1.
Figure 1.
Average length of stay (in days) across regions between traditional Medicare and Medicare Advantage, 2019–2020. Source: Authors’ analysis of the Inpatient Rehabilitation Facility—Patient Assessment Instrument (IRF-PAI) data, 2019–2020. Each graph shows the average length of stay with 95% CIs in each region. The horizontal reference line represents the average length of stay across regions in each graph.
Figure 2.
Figure 2.
Map of average length of stay (in days) across the Centers for Medicare and Medicaid Services (CMS) regions, 2019–2020. Source: Authors’ analysis of the Inpatient Rehabilitation Facility—Patient Assessment Instrument (IRF-PAI) data, 2019–2020. Red numbers identify the 10 CMS administrative regions. Abbreviations: MA, Medicare Advantage; TM, traditional Medicare.
See this image and copyright information in PMC

References

    1. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003;138(4):273–287. - PubMed
    1. Institute of Medicine . Variation in Health Care Spending: Target Decision Making, Not Geography. Institute of Medicine (IOM), Board on Health Care Services, Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care; 2013. - PubMed
    1. Sood N, Yang Z, Huckfeldt P, Escarce J, Popescu I, Nuckols T. Geographic variation in Medicare fee-for-service health care expenditures before and after the passage of the Affordable Care Act. JAMA Health Forum. 2021;2(12):e214122. - PMC - PubMed
    1. Zhang Y, Li J. Geographic variation in Medicare per capita spending narrowed from 2007 to 2017. Health Aff (Millwood). 2020;39(11):1875–1882. - PMC - PubMed
    1. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003;138(4):288–298. - PubMed

LinkOut - more resources