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Medicare Managed Care More Apt for Nursing Home Residents

For residents with advanced dementia, care less burdensome with managed versus fee-for-service care
TUESDAY, Sept. 24 (HealthDay News) -- For nursing home residents with advanced dementia, Medicare managed care is associated with more appropriate, less burdensome care, according to a study published online Sept. 23 in JAMA Internal Medicine.
Keith S. Goldfeld, Dr.P.H., M.P.A., from the New York University School of Medicine in New York City, and colleagues compared patterns of care and quality outcomes over 18 months for nursing home residents with advanced dementia from 22 nursing homes covered by managed care (133 residents) or traditional fee-for-service care (158 residents).
The researchers found that, compared with residents enrolled in traditional Medicare fee-for-service, residents enrolled in managed care were significantly more likely to have do-not-hospitalize orders (adjusted odds ratio, 1.9); were significantly less likely to be transferred to the hospital for acute illness (adjusted odds ratio, 0.2); had significantly more primary care visits per 90 days (adjusted rate ratio, 1.3); and had significantly more visits from nurse practitioners (adjusted rate ratio, 3.0). No significant differences were seen across the groups in survival, comfort, or other treatment outcomes.
"Medicare managed-care programs may offer a promising approach to ensure that nursing homes are able to provide appropriate, less burdensome, and affordable care, especially at the end of life," the authors write.
Abstract (http://archinte.jamanetwork.com/article.aspx?articleid=1740697#Abstract )Full Text (subscription or payment may be required) (http://archinte.jamanetwork.com/article.aspx?articleid=1740697 )Editorial (subscription or payment may be required) (http://archinte.jamanetwork.com/article.aspx?articleid=1740696 )
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