Post Acute Care Episodes: Index

12/31/1969

Post Acute Care Episodes

Final Report

Prepared for

Susan Bogasky
November 2009

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

Melissa Morley, PhD Barbara Gage, PhD Laura Smith, PhD Pamela Spain, PhD Melvin Ingber, PhD
RTI International 1440 Main Street–Suite 310 Waltham, MA 02451-1523
RTI Project Number: 0208824.002.003

RTI International is a trade name of Research Triangle Institute.


This report is available on the Internet at:
http://aspe.hhs.gov/health/reports/09/pacepifinal/index.shtml

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ABSTRACT

This purpose of this project is to continue the ASPE bundling research in the area of Medicare post acute care using the 2006 Medicare post acute episode file developed in the previous analysis. This project considers 18 alternative Medicare acute hospital plus post-acute care episode definitions, models the impact on potential payment bundles, and examines differences in payments by geographic area using standardized payments.


This report was produced under the direction of Susan Bogasky, Project Officer, Office of the Assistant Secretary for Planning and Evaluation (ASPE), Office of Health Policy. The findings and conclusions of this report are those of the authors and do not necessarily represent the views of ASPE or HHS.

Material contained in this publication is in the public domain and may be reproduced, fully or partially, without permission of the Federal Government. The courtesy of attribution is requested. The recommended citation follows:

Office of Health Policy, ASPE(2010) Post Acute Care Episodes. Washington, DC:  U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.


Table of Contents

Background

Post-acute Care Episode Definitions

    Results

      Discussion

        References

         

        Table of Figures

        Figure 1. Fixed versus Variable Length Episodes

        Figure 2. Defining End Points of Fixed Episodes

        Figure 3. PAC Payments per PAC User—30 Day Fixed Episode Definitions, All MS-DRGs

        Figure 4. PAC Payments per PAC User—30 Day Fixed Episode Definitions, MS-DRG 470, Major Joint Replacement or Reattachment of Lower Extremity without Major Complication or Comorbidity

        Figure 5. PAC Payments per PAC User—30 Day Fixed Episode Definitions, MS-DRG 194, Simple Pneumonia and Pleurisy with Complication or Comorbidity

        Figure 6. PAC Payments per PAC User—30 Day Fixed, 60 Day Fixed, 90 Day Fixed, and 30 Day Variable Length Episode Definitions

        Figure 7. PAC Payments per PAC User Excluding Readmissions—30 Day Fixed, 60 Day Fixed, 90 Day Fixed, and 30 Day Variable Length Episode Definitions

         

        Tables

        Table 1. Medicare PAC Episode Payments per Index Acute Hospital Discharge and per PAC User, by Episode Definition

        Table 2. Medicare PAC Episode Payments and Utilization per PAC User, by Episode Definition

        Table 3. Medicare PAC Episode Payments and Utilization for PAC Users, by Service Type, by Episode Definition

        Table 4. Mean Payment per Service User, per PAC User, and per Index Acute Hospital Discharge, by 30 Day Episode Definition

        Table 5. PAC Standardized Payments by State, Episode Definition A—30 Day Fixed: Any Claim Starting within 30 Days

        Table 6. PAC Standardized Payments by CBSA, Episode Definition A—30 Day Fixed: Any Claim Starting within 30 Day

         


        How to Obtain a Printed Copy

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        Human Services Policy, Room 404E
        Assistant Secretary for Planning and Evaluation
        U.S. Department of Health and Human Services
        200 Independence Av, SW
        Washington, DC 20201

        Fax:  (202) 690-6562
        Email:  pic@hhs.gov

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        Last Updated: 03/15/2010