More Care Doesn't Equal Happier Patients in Traditional Medicare

The extremes of health care contact days—having too few or more than average—among community-dwelling beneficiaries 65 years and older of traditional Medicare have been associated with unnecessary care, misdirected care coordination, and excessive care outside the home, according to new research published online today in JAMA Internal Medicine.¹ Health care contact days are days spent receiving care outside of the home.

There is no limit on out-of-pocket (OOP) spending among individuals who have traditional Medicare coverage (Medicare parts A and B; hospital and medical insurance, respectively).² Medicare Part C plans (Medicare Advantage) have an OOP limit, which is $9350 for 2025 for approved services, as do Medigap policies (supplemental coverage). The financial implications of this lack of a limit could be great, especially for older beneficiaries on a fixed income alongside ever-increasing health care costs.

For this present study, data on over 13,000 patients with traditional Medicare coverage—representing a population of 28 million–plus patients—from the 2019 Medicare Current Beneficiary Survey show high levels of care satisfaction and reported ease in managing care; however, the investigators explained these results were observed alongside inverse relationships.¹ These data were analyzed between June and December of 2024.

The patients were divided into 3 cohorts: care satisfaction (n = 6218), ease managing care (n = 2980), and OOP spending (n = 3929). Most were 65 to 69 years or 70 to 74 years (59.3%, 58%, and 58.9%, respectively), female (53.9%, 55%, and 53.8%), reported an income above 200% of the federal poverty level (72.7%, 79.4%, and 73.6%), and had a metropolitan residence location (78.8%, 81.2%, and 77.9%). Very few patients reported Hispanic ethnicity (5.4%, 3.9%, and 5.2%) or African American (6.8%, 4.1%, and 6.5) or Asian (2.7%, 1.9%, 2.5%) race and no chronic conditions (11.2%, 7.9%, and 13.6%).

Less overall satisfaction among traditional Medicare beneficiaries may indicate barriers to accessing care because of too few contact days or that improved care quality and outcomes do not always result from more contact days. | Image Credit: © driftwood-stock.adobe.com

A majority also reported they were in good overall health and did not have functional impairment, excessively worry about their health, or avoid going to the doctor when they felt bad.

What they did report were high mean (SD) totals of contact days. Patients with data on care satisfaction had 20 (21.7) total days, or 2.3 (9.6) institutional days (hospital, emergency department, skilled-nursing facility, or hospice facility) and 17.7 (18.1) ambulatory care days; patients with data on ease managing care had 23.6 (21.2) total days, or 2.2 (7.6) and 21.4 (18.2), respectively; and patients with data on OOP spending had 19.3 (20.7), or 2.0 (8.1) and 17.3 (17.8).

Their mean overall OOP spending was $2596 ($4438). Further, the relationship between contact days and OOP spending was seen to be linear between 7 and 46 total contact days, with each additional contact day representing $48.81 in additional OOP spending (95% CI, $36.82-$6080).

Between 3 and 7 contact days after care initiation, both care satisfaction and reported ease of managing care dropped off significantly. Overall, just 58.1% of patients reported satisfaction with their care and 61.5%, ease in managing their care. These relationships were inverse, as previously stated, when accounting for total health care contact days. For the authors’ 4 time points—0, 50, 100, and 150 health care contact days—adjusted (sociodemographic and clinical factors, and care-seeking behaviors) and unadjusted models show care satisfaction quickly rising but then leveling off before day 50 and that opinions on ease in managing care began dropping after only a few days before also leveling off.

“Health care contact days can represent needed care and place burdens on older adults and caregivers,” the authors report. “For older Medicare beneficiaries, studies show that contact days vary by factors beyond medical need, suggesting modifiable overuse and underuse.”^3-5

They explain that the extremes they saw correlated with less overall satisfaction among traditional Medicare beneficiaries because too few contact days may indicate barriers to accessing care, while excessive contact days don't necessarily guarantee improved care quality or outcomes.¹

“Clinicians, researchers, and policymakers could use contact days to evaluate interventions and reduce excess contact days for patients,” the authors conclude, “by avoiding unnecessary care, improving care coordination, and shifting care to the home.”

References

1. Daley NE, Orav EJ, Ganguli I. Health care contact days, care experience, and out-of-pocket spending among traditional Medicare patients. JAMA Intern Med. Published online March 17, 2024. doi:10.1001/jamainternmed.2024.8517

2. What you'll pay in out-of-pocket Medicare costs in 2025. National Council on Aging. December 5, 2024. Accessed March 16, 2025. https://www.ncoa.org/article/what-you-will-pay-in-out-of-pocket-medicare-costs-in-2025/

3. Ganguli I, Chant ED, Orav EJ, Mehrotra A, Ritchie CS. Health care contact days among older adults in traditional Medicare: a cross-sectional study. Ann Intern Med. 2024;177(2):125-133. doi:10.7326/M23-2331

4. Chant ED, Ritchie CS, Orav EJ, Ganguli I. Healthcare contact days among older adults living with dementia. J Am Geriatr Soc. 2024;72(5):1476-1482. doi:10.1111/jgs.18744

5. Gupta A, Chant ED, Mohile S, et al. Health care contact days among older cancer survivors. JCO Oncol Pract. 2024;20(7):943-952. doi:10.1200/OP.23.00590