Do localized disasters impact clinical measures of health care quality?

Abstract

Objective: To describe the effect of geographically limited disasters on health plan (ie, contract) quality performance scores using a broad set of clinical quality and patient experience measures.

Study design: Retrospective analyses to assess the impact of disasters on Medicare Advantage contracts' quality-of-care performance scores in 2017 and 2018 for 11 Part C clinical quality and patient experience measures used in the Medicare Advantage Star Ratings.

Methods: We calculated each Medicare Advantage contract's disaster exposure using the percentage of the contract's beneficiaries residing in a Federal Emergency Management Agency-designated disaster area during the measurement period. Using linear mixed models, we estimated the association between contract-level disaster exposures and performance scores during the performance period measured, with random effects for contract and fixed effects for year, contract characteristics, and the disaster exposure, using repeated cross-sectional data on contracts from 2016 to 2018.

Results: We found no evidence that geographically limited disasters meaningfully affected contract quality performance scores. The disasters studied were associated with statistically significant but small changes in performance scores for 1 of 11 measures in both years.

Conclusions: The lack of evidence that being in a disaster-affected area had a meaningful negative impact on quality measure performance suggests that performance measurement programs are robust to the impact of short-term localized disasters and continue to function as intended.