Post-Acute Care Episodes Expanded Analytic File

03/01/2011

Post-Acute Care Episodes Expanded Analytic File

Final Report

April 2011

Prepared for:Susan Bogasky Assistant Secretary for Planning and Evaluation (ASPE) U.S. Department of Health and Human Services Hubert H. Humphrey Building, Room 443F5 200 Independence Avenue, SW Washington, DC 20201

Prepared by: Barbara Gage, PhD, Melissa Morley, PhD, Melvin Ingber, PhD, and Laura Smith, PhD RTI International 1440 Main Street, Suite 310 Waltham, MA 02451

RTI Project Number 0208824.002.007

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U.S. Department of Health and Human Services In Collaboration with the U.S. Department of Labor

This report is available on the Internet at:http://aspe.hhs.gov/health/reports/2011/PACexpanded/

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This study provides an opportunity to explore additional research questions as the Assistant Secretary for Planning and Evaluation (ASPE) and the Centers for Medicare and Medicaid Services (CMS) continue to consider alternatives to the prospective payment silos in post-acute care (PAC).

This project expands ASPE's Medicare post-acute care (PAC) episode analytic file in terms of sample size and the number of years used (2006-2008) to provide more detailed characteristics of PAC episodes under different definitions. This analysis provides information on changes in PAC use, allows for more detailed understanding of the patterns of PAC use by geography, and provides a cross-sectional and longitudinal analysis. In addition, this work uses acute Medicare hospital and community entrant initiated episode definitions.

Contents

1. Background

2. Post-Acute Care Episode Definitions2.1 Definition of an Initiating Event2.2 Analytic Samples2.3 Episode Definitions2.4 Diagnosis and Severity Adjustment2.5 Standardizing Payments for Geographic Benchmarking Analysis2.6 Cohort Analysis

3. Acute Hospital-Initiated Episodes

4. Community-Initiated Episodes4.1 HHA-Initiated Episodes4.2 LTCH-Initiated Episodes4.3 IRF-Initiated Episodes4.4 Conclusion

5. Mortality Analyses

6. Geographic Benchmarking

7. Longitudinal Cohort Analyses

8. Discussion and Policy Implications

9. References

Figures

1. Analytic Samples: Longitudinal Cohort and Cross Section

2. Fixed-Length versus Variable-Length Episodes

3. Defining Endpoints of Fixed-Length Episodes

4. Benchmarking Analysis: Mean PAC Episode Payment Per PAC User, and Per Discharge for Acute Initiated Episodes, By State, Episode Definition 30-day Fixed Any Claim Starting Within 30 Days, 2008

5. Percentage of Beneficiaries With an Acute or PAC Claim Following Discharge From Initiating Event, by Type of Initiating Event

6. Mean Acute and PAC Payments Per PAC User Following Discharge From Initiating Event, by Type of Initiating Event

7. Percentage of Beneficiaries With an Acute, PAC, or Physician Claim Following Discharge From an Acute Initiating Event, by Type of Claim

8. Mean Acute, PAC, and Physician Payments Per User PAC User Following Discharge From an Acute Hospital-Initiated Event, by Type of Claim

9. Mean Acute and PAC Payments Per PAC User Following Discharge From an Acute Initiating Event, by MS-DRG

10. Mean Acute, PAC, and Physician Payments Per User PAC User Following Discharge From an Acute Initiating Event, by Type of Claim, MS-DRG 470, "Major Joint Replacement or Reattachment of Lower Extremity w/o MCC"

11. Mean Acute, PAC, and Physician Payments Per User PAC User Following Discharge From an Acute Initiating Event, by Type of Claim, MS-DRG 194, "Simple Pneumonia & Pleurisy w CC"

Tables

1. Initiating Events for Post-Acute Care Episodes

2. Episode Definitions

3. Top 10 MS-DRGs for Acute Hospital-Initiated Episodes for Beneficiaries Discharged to PAC

4. First Site of PAC, Acute Hospital-Initiated Episodes, Overall and for Top 5 MS-DRGs by Volume of PAC Users, 2006-2008

5. Episode Patterns: Acute Hospital-Initiated Episodes, 2008

6. Episode Summary Statistics: Acute Hospital-Initiated Episodes, 2006-2008

7. Episode Summary Statistics: Acute Hospital-Initiated Episodes, by MS-DRG for Top 5 MS-DRGs by Volume of PAC Users, 2008

8. Episode Length of Stay: Acute Hospital-Initiated Episodes, 2008

9. Service-Specific Episode Summary Statistics, Acute Hospital-Initiated Episodes, 2008

10. Physician Service Use, Acute Hospital-Initiated Episodes, by MS-DRG for Top 5 MS-DRGs by Volume of PAC Users, 2008

11. Top 10 Condition Groupings: HHA-Initiated Episodes, 2006-2008

12. Top 10 ICD-9 Codes (Primary) Coded on HHA Claims, Acute Hospital-Initiated Episodes for Beneficiaries Discharged to HHA and HHA-Initiated Episodes, 2008

13. Top 10 HHRGs Coded on HHA Claims, Acute Hospital-Initiated Episodes for Beneficiaries Discharged to HHA and HHA-Initiated Episodes, 2008

14. Episode Patterns: HHA-Initiated Episodes, 2008

15. Episode Patterns: Acute Hospital-Initiated Episodes, Beneficiaries Discharged to HHA, 2008

16. Episode Summary Statistics: HHA-Initiated Episodes, 2006-2008

17. HHA Utilization, HHA Initiated Episodes versus Beneficiaries With Acute Hospital-Initiated Episodes Discharged to HHA, 2006-2008

18. Service-Specific Episode Summary Statistics: HHA-Initiated Episodes, 2008

19. Service-Specific Episode Summary Statistics: Acute Hospital-Initiated Episodes, Beneficiaries Discharged to HHA, 2008

20. Physician Service Use, by Condition Grouping and by Episode Definition: HHA-Initiated Episodes, 2008

21. Top 10 MS-DRGs for LTCH-Initiated Episodes, 2006-2008

22. Top 10 MS-DRGs for Acute Hospital-Initiated Episodes, Beneficiaries Discharged to LTCH, 2008

23. Episode Patterns: LTCH-Initiated Episodes, 2008

24. Episode Patterns: Acute Hospital-Initiated Episodes, Beneficiaries Discharged to LTCH 2008

25. Episode Summary Statistics: LTCH-Initiated Episodes, 2006-2008

26. LTCH Utilization, LTCH Initiated Episodes versus Beneficiaries With Acute Initiated Episodes Discharged to LTCH, 2006-2008

27. Service-Specific Episode Summary Statistics: LTCH-Initiated Episodes, 2008

28. Service-Specific Episode Summary Statistics: Acute Hospital-Initiated Episodes, Beneficiaries Discharged to LTCH, 2008

29. Physician Service Use, by MS-DRG and by Episode Definition: LTCH-Initiated Episodes, 2008

30. Top 10 RICs, IRF-Initiated Episodes, 2006-2008

31. Top 10 RICs, Acute Hospital-Initiated Episodes, Beneficiaries Discharged to IRF, 2008

32. Episode Patterns: IRF-Initiated Episodes, 2008

33. Episode Patterns: Acute Hospital-Initiated Episodes, Beneficiaries Discharged to IRF, 2008

34. Summary Statistics: IRF-Initiated Episodes, 2006-2008

35. IRF Utilization, IRF Initiated Episodes versus Beneficiaries With Acute Initiated Episodes Discharged to IRF, 2006-2008

36. Service-Specific Summary Statistics: IRF-Initiated Episodes, 2008

37. Service-Specific Episode Summary Statistics: Acute Hospital-Initiated Episodes, Beneficiaries Discharged to IRF, 2008

38. Physician Service Use, by RIC and by Episode Definition: IRF-Initiated Episodes, 2008

39. Mortality Analyses, Acute Hospital-Initiated Episodes, 30-Day Variable-Length Episode Definition, 2008

40. Mortality Analyses, Acute Hospital-Initiated Episodes, 30-Day Fixed-Length Episode Definition, 2008

41. Mortality Analyses, HHA-Initiated Episodes, 30-Day Variable-Length Episode Definition, 2008

42. Mortality Analyses, HHA-Initiated Episodes, 30-Day Fixed-Length Episode Definition, 2008

43. Mortality Analyses, LTCH-Initiated Episodes, 30-Day Variable-Length Episode, 2008

44. Mortality Analyses, LTCH-Initiated Episodes, 30-Day Fixed-Length Episode Definition, 2008

45. Mortality Analyses, IRF-Initiated Episodes, 30-Day Variable-Length Episode Definition, 2008

46. Mortality Analyses, IRF-Initiated Episodes, 30-Day Fixed-Length Episode Definition, 2008

47. Standardized Post-Acute Care Payments for Acute Hospital-Initiated Episodes, by State, 2008, Episode Definition 30-Day Fixed: Any Claim Starting Within 30 Days

48. Standardized Post-Acute Care Payments for Acute Hospital-Initiated Episodes, by CBSA, 2008, Episode Definition of 30-Day Fixed: Any Claim Starting Within 30 Days

49. Standardized Post-Acute Care Payments for HHA-Initiated Episodes, by State, 2008, Episode Definition of 30-Day Fixed: Any Claim Starting Within 30 Days

50. Standardized Post-Acute Care Payments for HHA-Initiated Episodes, by CBSA, 2008, Episode Definition of 30-Day Fixed: Any Claim Starting Within 30 Days

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