A new study comparing the health outcomes of more than 300,000 Medicare patients who completed rehabilitation therapy after hospitalization for hip fractures found that more care may not translate to better long-term health. The study, conducted by researchers at Brown University's School of Public Health and published in PLOS Medicine, found that patients covered under Medicare's fee-for-service plan spent an average of 31 days in nursing homes following hip fracture hospitalization. 

Researchers hypothesized that those who had received more care would fare better after their release. In reality, the opposite happened. Despite significantly fewer days of care, patients covered under Medicare Advantage saw slightly better health outcomes after release.

The study emerges as an increasing number of elderly Americans are opting for the newer Medicare Advantage plan, which offers coverage through private insurance companies that have been vetted by Medicare.


The traditional fee-for-service plan, sometimes called Original Medicare, allows enrollees to choose any physician they want, and Medicare is billed on a per-treatment basis.  The results suggest that for hip fracture patients who are otherwise healthy, longer lengths of stay in skilled nursing facilities may not translate to better outcomes. 

They suggests that it may be possible for nursing homes to order shorter courses of rehabilitation without compromising health which would save time for patients and money for Medicare.

Better Care

Mor said this study's results build on previous research linking fewer minutes of care and better outcomes to the Medicare Advantage plan. "There is reasonably good evidence to suggest that for every full day fee-for-service patients spend in the hospital, Medicare Advantage patients undergoing the same treatment spend a little bit less than a day in the hospital and have similar or better outcomes," Mor said.

He noted that record numbers of Americans are opting for the newer Medicare Advantage plans over Original Medicare. In decades past, those who used Medicare Advantage made up just 5 to 10% of all Medicare enrollees.  Mor believes the increase could be due to Medicare Advantage's relative simplicity.

Under Original Medicare, patients can visit any medical professional they choose but with frequent visits, copayments can add up quickly, and the paperwork piles up fast. Those enrolled in Medicare Advantage must choose from providers within a restricted network, but the plans tend to be more affordable and less confusing to navigate.

The increase in Medicare Advantage enrollees has brought big changes to health care operations, Mor noted. Original Medicare's pay-per-treatment setup has long incentivized more treatments and longer stays in rehabilitation facilities. But Medicare Advantage, with its fixed-payment arrangement, gives providers an incentive to discharge patients sooner.

Care Services

Mor said Medicare is also pushing for a "bundled" approach to payment for care services. Bundling would allow Medicare to cover the entire cost of a patient's single illness or course of treatment in a single payment to providers, regardless of that patient's plan.

"Most people don't want to be in a nursing home longer than they have to be," Mor said. The PLOS Medicine study was part of a long-term project funded by National Institute on Aging grants that examine how American nursing homes and long-term care have changed in the last several decades.