More black people than white people with Medicare tend to be readmitted to the hospital within a month after major surgery and the racial disparity is even greater within the Medicare Advantage managed care program, according to a research study led by University of Rochester professors published in Health Affairs.

The researchers compared racial disparities in 30-day readmissions between traditional Medicare fee-for-service and Medicare Advantage beneficiaries who underwent one of six major surgeries in New York State in 2013. After controlling for patient, hospital, and geographic characteristics, the study shows in traditional Medicare, black patients are 33 percent more likely than white patients to be readmitted, whereas in the Medicare Advantage managed care program, black patients are 64 percent more likely than white patients to be readmitted.

The researchers conclude it was not “entirely clear” whether blacks might fare better or worse than whites in managed care plans than they do in the fee-for-service program.

“On the one hand, managed care limits beneficiaries’ choice of providers with gatekeeping policies and restricted provider networks,” the researchers write. “The relative lack of choice in post-discharge ambulatory care, although it could not be directly tested in this study, might be particularly restricting for black Medicare Advantage beneficiaries who may have difficulties finding linguistically and culturally appropriate primary care providers.”

“On the other hand, managed care provides targeted education to improve health behaviors, emphasizes more use of preventive care, and has devoted resources to the implementation of practice guidelines, all of which may be more relevant for black patients’ post-discharge care and may help equalize the risk for postsurgical readmissions across racial groups,” they write.

The researchers believe these managed care mechanisms may collectively help reduce thirty-day readmissions for white Medicare Advantage patients, but work in the opposite way for black Medicare Advantage patients relative to their traditional Medicare counterparts.

“Further research is needed to understand whether newer health care delivery models, such as accountable care organizations, will help narrow the gap in readmission outcomes between black and white patients,” the researchers say.

They concede there are several limitations to their study, including that the sample did not include other types of medical procedures or residents of other states. Moreover, even after controlling for patient, hospital, and geographic characteristics, “it is possible that the racial disparities we found were partially mediated by other key patient characteristics, such as variations in unmeasured socioeconomic status, health behaviors, or the availability of community-based support.”

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Medicare Advantage associated with more racial disparity, study says

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