Surgical Outcomes and Postacute Care Use Among Rural Medicare Advantage Beneficiaries

Background: Medicare Advantage (MA) enrollment is growing rapidly in rural areas, but little is known about how MA influences surgical care delivery and outcomes. Given differences in care coordination, network structures, and reimbursement, MA may impact where rural patients undergo surgery, care quality, and access to postacute care. Methods: We conducted a retrospective cohort study using Medicare claims data (2016–2020) to identify rural beneficiaries who underwent one of 3 access-sensitive operations: abdominal aortic aneurysm repair, colectomy for cancer, or incisional hernia repair. Rural beneficiaries were identified using Rural–Urban Commuting Area codes. Beneficiaries were then classified as being enrolled in an MA or traditional fee-for-service (FFS) plan. Risk-adjusted outcomes were assessed using multivariable logistic regressions that accounted for patient characteristics, admission type, hospital characteristics, and year of surgery. Analyses were performed for the pooled cohort and separately for each of our 3 procedure types. Findings: We identified 176,864 Medicare beneficiaries who underwent surgery in our cohort. 26.3% were enrolled in MA. Risk-adjusted 30-day mortality rates (4.9% vs. 5.0%, P = 0.23) and complication rates (24.6% vs. 24.4%, P = 0.25) were not statistically different among MA versus FFS beneficiaries, but MA patients had significantly fewer risk-adjusted readmissions (12.5% vs. 14.6%, P < 0.001). Upon discharge, MA patients were more likely to be discharged home (odds ratio [OR] = 1.27, 95% confidence interval [CI]: 1.23–1.32, P < 0.001) and less likely to be discharged to a skilled nursing facility (OR = 0.82, 95% CI: 0.79–0.86, P < 0.001). Conclusions: Among rural surgical patients, beneficiaries enrolled in MA plans experienced similar mortality and overall complication rates but lower readmissions and less use of postacute care resources compared with FFS Medicare.