Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Overview of Analyses Conducted


Basic descriptive analyses for each state and episode grouper provide a broad overview of the number of episodes comprised by care delivered to Medicare beneficiaries who reside in the three states. These analyses include such summary statistics such as the number of beneficiaries who are in the analytic sample, the number of created and complete episodes created, percentage of claims that cannot be assigned to episodes, average number of episodes per beneficiary, total Medicare payments represented by claims in the sample, and percentage of episodes and percentage of payments represented by conditions of focus.

Additional detailed analyses focus on the clinical conditions listed above.  The analyses presented below examined the settings and number of providers that are included in episodes for each of the conditions to facilitate the exploration of issues around alignment of performance measurement and financial incentives across providers and settings. We investigated the other episodes commonly constructed for these beneficiaries to assist our understanding of the extent to which related care might not be captured in the episodes clearly related to the clinical conditions of focus (e.g. home health care after a hospitalization for congestive heart failure). We also explored a variety of attribution rules that could be used to assign accountability to an individual or multiple providers and types of providers.

Complex patients are a particular interest because a substantial fraction of Medicare beneficiaries have multiple chronic conditions. To facilitate our understanding of whether and how having multiple conditions affects the care received for an episode for the conditions of interest in this project (e.g. the costs of the episode, number of settings in which they receive care, the number of providers they see as part of the episode, and the number of other types of episodes experienced); we stratified many of the condition-specific analyses by the level of comorbidity experienced by patients. We used the total number of episodes experienced by a beneficiary to assess patient burden of comorbidity and created three levels of comorbidity: up to 5 episodes, 6-11 episodes, 12 or more episodes. In terms of the number of episodes experienced by our study population, these categories represent the lowest 25 percent, the middle 50 percent and the upper 25 percent. The condition-specific analyses were also stratified by state in order to examine the extent to which there are differences in episodes and their composition across the three states included in the analyses.

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