Regional Variation in Length of Stay for Stroke Inpatient Rehabilitation in Traditional Medicare and Medicare Advantage

Regional variation in healthcare use threatens efficient and equitable resource allocation. Within the Medicare program, variation in care delivery may differ between centrally administered traditional Medicare (TM) and privately managed Medicare Advantage (MA) plans which rely on different strategies to control care utilization. As MA enrollment grows, it is particularly important for program design and long-term healthcare equity to understand regional variation between TM and MA plans. This study examined regional variation in length of stay (LOS) for stroke inpatient rehabilitation between TM and MA plans in 2019 and how that changed in 2020, the first year of the COVID-19 pandemic. Results showed that MA plans had larger across-region variations than TM (standard deviation (SD)=0.26 vs. 0.24 days, 11% relative difference). In 2020, across-region variation for MA further enlarged but the trend for TM stayed relatively stable. Market competition among all inpatient rehabilitation facilities (IRFs) within a region was associated with a moderate increase in within-region variation of LOS (elasticity=0.46). Policies reducing administrative variation across MA plans or increasing regional market competition among IRFs can mitigate regional variation in healthcare use.