Racial disparity in surgical readmissions greater among Medicare Advantage patients

Black surgical patients in both traditional Medicare and Medicare Advantage (MA) were more likely than white patients to be readmitted to the hospital within 30 days, but for MA beneficiaries, the racial disparity was much greater.

The study, led by University of Rochester School of Medicine and Dentistry professor Yue Li, PhD, and published by Health Affairs, used data for Medicare fee-for-service and MA beneficiaries in New York in 2013. The sample was limited to patients who underwent one of six surgeries: isolated coronary artery bypass graft (CABG), pulmonary lobectomy, endovascular repair of abdominal aortic aneurysm, open repair of abdominal aortic aneurysm, colectomy and hip replacement. In all, more than 13,000 traditional Medicare patients and 6,600 MA beneficiaries were included.

Before accounting for race, there was little difference in readmissions between the type of Medicare coverage (13.2 percent for Medicare FFS, 13.1 for MA). For Medicare FFS, white patients had a 11.2 percent 30-day readmission rate compared to 15.5 percent for black patients. Among MA beneficiaries, the disparity grew, with a 9.8 percent readmission rate for whites versus 17.2 percent for black patients.

The findings align with other recent Health Affairs studies showing racial disparities on quality, including among acute MI patients and in receiving low-value care.

“Our findings of persistent racial disparities in surgical readmissions despite the national trend are troubling, and they may suggest that recent readmission reduction efforts were broadly targeted—incorporating few incentives for reducing disparities beyond overall reduced readmissions,” Li and his coauthors wrote. “Our findings of racial disparities in surgical readmissions suggest that existing payment reforms could be revised to avoid potential unintended effects and that initiatives targeting disadvantaged groups could be developed to address persistent disparities.”