Patients With Dementia in ACOs Have Higher Costs, Care Burden Compared With Medicare Advantage

Decedents with dementia covered under accountable care organizations (ACOs) did not experience less costly or potentially burdensome end-of-life care than those with traditional Medicare (TM) despite ACOs’ cost incentives, according to a new study published in the Journal of American Geriatric Society.

The study compared end-of-life care for patients with dementia enrolled in TM with those covered by Medicare Advantage (MA) and ACOs, which both operate under incentives to reduce cost and care burden. Only MA enrollees experienced less costly care than those with TM, which would suggest that ACOs need policy changes, researchers concluded.

Researchers evaluated 370,094 dementia decedents who had a nursing home stay between 91 and 180 days before death, two or more functional impairments, and cognitive impairment ranging from mild to severe. Of those:

• 93,801 (25.4%) were in enrolled in MA (mean age 86.9, 67.6% female);
• 39,586 (10.75) were ACO attributed (mean age 87.2, 67.3% female); and
• 236,707 (63.9%) were enrolled in TM (mean age 87, 67.6% female).

In the last month of life, 27.9% of TM enrollees and 28.1% of those ACO attributed were hospitalized, compared to 20.5% of MA enrollees.

Researchers found an adjusted odds of hospitalization in the last 30 days of life to be 0.72 among MA enrollees and 1.05 among those attributed to ACOs, relative to TM enrollees. Adjusted odds of death in the hospital were 0.78 among MA enrollees and 1.02 among ACO attributed patients. Additionally, MA enrollees were less likely (0.80) to use invasive mechanical ventilation than those in TM.

The study accounted for sociodemographics, functional and cognitive impairments, comorbidities, and Hospital Referral Region to determine adjusted odds.

Reference:
Teno JM, Keohane LM, Mitchell SL, et al. Dying with dementia in Medicare Advantage, accountable care organizations, or traditional Medicare [published online ahead of print May 14, 2021]. J Am Geriatr Soc. 2021;10.1111/jgs.17225. doi:10.1111/jgs.17225