Importance Medicare–Medicaid dual eligible beneficiaries experience pronounced disparities in stroke recovery. However, it remains unclear whether inpatient rehabilitation services and outcomes are comparable between dual-eligible beneficiaries enrolled in Medicare fee-for-service (FFS) versus Medicare Advantage (MA) plans.

Objective To compare rehabilitation therapy utilization and associated outcomes among dual-eligible beneficiaries enrolled in FFS versus MA plans with stroke.

Design Retrospective cohort study.

Setting Inpatient Rehabilitation Facilities (IRF).

Participants Medicare beneficiaries admitted to IRF with stroke (n=125,782) between 2017 and 2019.

Exposure Dual-eligible beneficiaries enrolled in FFS versus MA plans.

Main Outcome Measures Total number of minutes of physical and occupational therapy provided within the first 2 weeks of IRF stay, self-care and mobility change scores, and 30-day all-cause hospital readmission.

Results For the first 2 weeks of therapy utilization, we did not find significant differences between the four groups. Using the non-dual FFS beneficiaries and low category of change as a reference, we found significantly lower likelihood of achieving high change in self-care scores for the dual FFS (OR=0.73, 95% CI=0.69-0.76), and dual MA (OR=0.93, 95% CI=0.88-0.98). However, non-dual MA patients had a higher likelihood of changes in self-care scores (OR=1.17, 95% CI=1.13-1.22). Similar trends were found for the mobility change scores, compared to non-dual FFS: dual FFS (OR=0.72, 95% CI=0.68-0.75), and dual MA (OR=0.91, 95% CI=0.86-0.96) and non-dual MA (OR=1.16, 95% CI=1.12-1.20). For 30-day readmission risk, dual FFS showed a higher likelihood of readmission (OR=1.19, 95% CI=1.08-1.31), while non-dual MA had a significantly lower likelihood (OR=0.77, 95% CI=0.71-0.83).

Conclusions and Relevance Although no differences in rehabilitation therapy utilization for stroke among dual-eligible beneficiaries, they had poorer functional recovery and higher 30-day readmission risk irrespective of FFS vs MA. Whereas non–dual-eligible MA beneficiaries experienced favorable outcomes. These findings underscore the importance of addressing post-IRF discharge needs among disadvantaged populations.

The authors have declared no competing interest.

This research was supported by National Institute of Health grants: R01MD017719 (PI: Kumar). The funder played no role in the design, conduct, or reporting of this study.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Virginia Commonwealth University (VCU)

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Due to access restrictions on the CMS data specified in the Data Use Agreement (DUA), we will not be able to make the data available; however, all the data sets used for this study can be obtained directly from the CMS after establishing a DUA.