Examining Post Acute Care Relationships in an Integrated Hospital System. Footnotes

02/01/2009

1 Medicare Benefit Policy Manual, Chapter 3 Duration of Covered Inpatient Services.

2 Medicare Benefit Policy Manual, Chapter 7 Home Health Services.

3 An index hospitalization is an acute hospitalization with a prior 60-day clean period. In the prior 60 days, no acute or post-acute (IRF, LTCH, SNF, HHA, outpatient therapy) services were used.

4 Some episodes may end at hospital discharge. Only live hospital discharges are included in the analytic sample.

5 Past work by Gage and colleagues showed variations in per case margins for different types of cases (Gage, et al, 2007)

6 This 15.0 percent is based on the number of index acute admissions (310,628 discharged alive) using the 5.0 percent sample, multiplied by 20 to estimate the number of index acute admissions in the Medicare population, divided by the total number of Medicare beneficiaries with Hospital Insurance as reported in the 2007 Statistical Supplement of the Health Care Financing Review (42,975,000 beneficiaries with hospital insurance in 2006).

7 FY 2006 DRG titles were used in this analysis.

8 LTCHs are not allowed to open units within hospitals. They are subject to separateness and control policies for colocated providers for hospital-within-hospitals [42 CFR 412.22(e)] and satellites [42 CFR 412.22(h)]. LTCHs must meet the same conditions of participation as acute hospitals including establishing a board and having a separate chief executive officer and medical director.

9 Note that episodes continuing beyond the first 6 months of 2007 were truncated and in these cases all available claims were assigned to the episode.

10 Though the sample is limited to beneficiaries discharged alive from the index acute hospitalization, the sample does include beneficiaries who die during PAC episodes.

11 LTCHs are not allowed to open units within hospitals. They are subject to separateness and control policies for colocated providers for hospital-within-hospitals [42 CFR 412.22(e)] and satellites [42 CFR 412.22(h)]. LTCHs must meet the same conditions of participation as acute hospitals including establishing a board and having a separate chief executive officer and medical director.

12 This 15.0 percent is based on the number of index acute admissions (310,628 discharged alive) using the 5.0 percent sample, multiplied by 20 to estimate the number of index acute admissions in the Medicare population, divided by the total number of Medicare beneficiaries with Hospital Insurance as reported in the 2007 Statistical Supplement of the Health Care Financing Review (42,975,000 beneficiaries with hospital insurance in 2006).

13 Note that the 2006 claims data were run through the 2008 MS-DRG grouper.

14 There are many services, particularly surgeries, that have an associated global period in which follow-up visits are included in the physician service payment. The global period for major surgery is 90 days. When no-pay claims are not submitted for such visits, they do not appear in the counts.

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