In previous work, RTI has examined PAC episodes initiating with an acute hospitalization. However, as ASPE and CMS begin to consider alternatives to silo-based payments, it is necessary to also consider service use that occurs without the presence of an acute hospitalization, so-called "community entrants." For example, beneficiaries may enter home health services without having an acute hospital stay. In this work RTI has also constructed episodes that begin with HHA, IRF, and LTCH. The purpose of the community entrant analysis is to provide a baseline understanding of the characteristics of beneficiaries who enter care without an acute hospital stay. Table 1
summarizes the services that initiate episodes in our analyses.
Table 1. Initiating Events for Post-Acute Care Episodes
|Episode Initiating Event
||Initiating Claim Type
|1. Acute hospital-initiated episode
|2. Community entrant episode
- Home Health (HHA)
- Inpatient Rehabilitation Hospital (IRF)
- Long-Term-Care Hospital (LTCH)
RTI's past work constructing PAC episodes (Gage et al., 2009; Morley et al., 2009) required a 60-day clean period for an acute hospitalization to initiate an episode of care. This clean period was defined as the absence of acute hospital and PAC services (HHA, LTCH, IRF, and skilled nursing facility [SNF]). In the current work, RTI has replaced the 60-day clean period with a 30-day clean period. The decision to reduce the clean period to 30 days was based on earlier work with ASPE looking at time-based episode definitions. This decrease in the required gap in services prior to initiating an episode is likely to result in inclusion of a broader range of beneficiaries who may be in and out of acute and Post-Acute care.