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

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

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

“On the one hand, managed care limits beneficiaries’ choice ofproviders with gatekeeping policies and restricted providernetworks,” the researchers write. “The relative lack of choice inpost-discharge ambulatory care, although it could not be directlytested in this study, might be particularly restricting for blackMedicare Advantage beneficiaries who may have difficulties findinglinguistically and culturally appropriate primary careproviders.”

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

The researchers believe these managed care mechanisms maycollectively help reduce thirty-day readmissions for white MedicareAdvantage patients, but work in the opposite way for black MedicareAdvantage patients relative to their traditional Medicarecounterparts.

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“Further research is needed to understand whether newer healthcare delivery models, such as accountable care organizations, willhelp narrow the gap in readmission outcomes between black and whitepatients,” the researchers say.

They concede there are several limitations to their study,including that the sample did not include other types of medicalprocedures or residents of other states. Moreover, even aftercontrolling for patient, hospital, and geographic characteristics,“it is possible that the racial disparities we found were partiallymediated by other key patient characteristics, such as variationsin unmeasured socioeconomic status, health behaviors, or theavailability of community-based support.”