Post-Acute Care Episodes Expanded Analytic File. 7. Longitudinal Cohort Analyses

04/01/2011

The final set of analyses was conducted on the longitudinal cohort analytic sample described in Section 2. This analytic sample was developed to allow us to follow beneficiary utilization patterns over a 2-year period to learn more about patterns of service use for different types of beneficiaries beyond what we observe in the first episode. The analyses presented here provide information on utilization and payments for twenty-four 30-day windows following discharge from an initiating event. Data are presented by initiating event (acute, HHA, LTCH, and IRF). For beneficiaries with acute hospital-initiated episodes, additional information on service-specific utilization and utilization by index acute MS-DRG is also presented.

Figure 5 shows the proportion of beneficiaries with an acute or PAC claim (HHA, SNF, IRF, LTCH, or therapy) in each of the twenty-four 30-day windows following discharge from an initiating event. Data are shown here for beneficiaries with acute, HHA, LTCH, and IRF-initiated episodes. Within the first 90 days following discharge from an initiating event, beneficiaries with acute hospital-initiated episodes have the highest proportion of beneficiaries using acute or PAC service, followed by beneficiaries with an IRF-initiated episode. Of beneficiaries with an acute hospital-initiated event, 100 percent had a claim in the first window (days 1 to 30 following discharge from the acute initiating event) because our sample focused on PAC users. After 90 days, the proportion of beneficiaries with acute hospital-initiated episodes with an acute or PAC claim decreases significantly and is lower than among any of the beneficiaries with community-initiated episodes. After day 90 and for the remainder of the 2-year period examined here, beneficiaries with HHA-initiated episodes have the highest proportion of beneficiaries with an acute or PAC claim, indicating that these beneficiaries may be more likely to be chronically ill and in need of ongoing care.

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

Figure 5.   

Figure 5 reports the percentage of beneficiaries with at least one acute or PAC claim following discharge from an initiating event, by initiating event, for each of the twenty-four 30-day windows included in the longitudinal cohort analysis.

Note: All initiating events occurred in 2006. Twenty-four 30-day windows were constructed following discharge from the initiating event to follow service use for 2 years.
Source: RTI analysis of 2006, 2007, and 2008 Medicare claims (M3MM197).

While Figure 5 provides information on the percentage of beneficiaries using different services following discharge from an initiating event, Figure 6 provides information on the payment associated with that service use by type of initiating event. Payments are presented per PAC user, so the denominator is constant across each window and includes all beneficiaries with an initiating event. Mean payments per PAC user are highest for beneficiaries with acute hospital-initiated episodes in the first 30 days following discharge from the initiating event, but for the remainder of the analysis period, beneficiaries with LTCH-initiated episodes have the highest payments per PAC user. Although beneficiaries with HHA-initiated episodes had the highest proportion of beneficiaries with at least one acute or PAC claim after 90 days (as seen in Figure 5), the payments associated with this use are low and likely indicative of ongoing HHA and therapy services.

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

Figure 6.   

Figure 6 reports the mean acute and PAC payments per PAC User following discharge from an initiating event, by initiating event, for each of the twenty-four 30-day windows included in the longitudinal cohort analysis.

Note: All initiating events occurred in 2006. Twenty-four 30-day windows were constructed following discharge from the initiating event to follow service use for 2 years.
Source: RTI analysis of 2006, 2007, and 2008 Medicare claims (M3MM197).

For beneficiaries with acute hospital-initiated episodes, Figure 7 and Figure 8 provide more detail on the percentage of beneficiaries with a claim by service type and the mean payments per PAC user by service type. Although physician service use is not included in Figure 5 or Figure 6, these services were included in Figure 7 and Figure 8 to demonstrate the high proportion of physician service use following discharge from an acute hospital-initiated episode and the continued use of these services over the 2-year period. In looking specifically at PAC services, HHA and SNF service use is relatively high compared with other PAC services in the first 90 days following discharge from an acute hospitalization. While 10 percent of beneficiaries use IRF in the first 30 days after discharge, this percentage decreases to less than 1 percent for the remainder of the analysis period. The proportion of beneficiaries with an acute hospitalization is highest in the first 90 days following discharge from the index hospitalization and then decreases for the remainder of the analysis period. After day 90, use of HHA and acute hospitalization are most common among beneficiaries with acute hospital-initiated episodes. The payments per PAC user shown in Figure 8 reveal that the payments per PAC user for SNF are highest up until day 60, but the payments per PAC user for acute hospitalizations are highest for the remainder of the analysis period. Although a high proportion of beneficiaries use physician services in each window, the payments associated with these services are very low.

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

Figure 7.    

Figure 7 reports the percentage of beneficiaries with at least one acute, PAC, or physician claim following discharge from a acute hospital-initiating event, by type of claim (HHA, IRF, LTCH, SNF, readmission, hospital outpatient therapy, independent therapy and physician services) for each of the twenty-four 30-day windows included in the longitudinal cohort analysis.

Note: All initiating events occurred in 2006. Twenty-four 30-day windows were constructed following discharge from the initiating event to follow service use for 2 years.
Source: RTI analysis of 2006, 2007, and 2008 Medicare claims (M3MM181).

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

Figure 8.    

Figure 8 reports the mean acute, PAC, and physician payments per PAC Users following discharge from an acute hospital-initiating event, by type of claim (HHA, IRF, LTCH, SNF, readmission, hospital outpatient therapy, independent therapy and physician services) for each of the twenty-four 30-day windows included in the longitudinal cohort analysis.

Note: All initiating events occurred in 2006. Twenty-four 30-day windows were constructed following discharge from the initiating event to follow service use for 2 years.
Source: RTI analysis of 2006, 2007, and 2008 Medicare claims (M3MM181).

To learn more about the differences in use patterns over a 2-year period for beneficiaries with different diagnoses in their acute initiating event, we looked at the mean acute and PAC payments for beneficiaries in the top five MS-DRGs in terms of volume of discharges to PAC (Figure 9). Beneficiaries in MS-DRG 065, "Intracranial hemorrhage or cerebral infarction w CC," and beneficiaries in MS-DRG 481, "Hip & femur procedures except major joint w CC," had the highest payments per PAC user for the first 90 days following discharge from the index acute hospitalization. Payments per PAC user for beneficiaries in MS-DRG 470 decreased at the fastest rate and were lowest among the top five MS-DRGs starting at 30 days following discharge from the index hospitalization.

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

Figure 9.    

Figure 9 reports the mean acute and PAC payments per PAC User following discharge from an acute hospital- initiating event, by MS-DRG, for each of the twenty-four 30-day windows included in the longitudinal cohort analysis. Five MS-DRGs are shown here including MS-DRG 470 "Major joint replacement or reattachment of lower extremity w/o MCC"; MS-DRG 194 "Simple pneumonia & pleurisy w CC; MS-DRG 065 "Intracranial hemorrhage or cerebral infarction w CC; MS-DRG 690 "Kidney & urinary tract infections w/o MCC'; and MS-DRG 481 "Hip & femur procedures except major join w CC."

Note: All initiating events occurred in 2006. Twenty-four 30-day windows were constructed following discharge from the initiating event to follow service use for 2 years.
Source: RTI analysis of 2006, 2007, and 2008 Medicare claims (M3MM181).

Figure 10 and Figure 11 show the mean payment per PAC user by service type for the top two MS-DRGs for beneficiaries with acute hospital-initiated episodes (MS-DRG 470, "Major joint replacement or reattachment of lower extremity w/o MCC" and MS-DRG 194, "Simple pneumonia & pleurisy w CC") to reveal more about differences in service-specific utilization for a rehabilitative diagnosis versus a medical diagnosis. Figures 10 and 11 use the same scale on the vertical axis to enable comparison of the mean payments across these two MS-DRGs. Most notably, the mean payments per PAC user for SNF and for acute hospitalizations were higher for beneficiaries in MS-DRG 194 across the analysis period compared with beneficiaries in MS-DRG 470. Mean payments per PAC user for HHA were higher for beneficiaries in MS-DRG 470 in the first 30 days following discharge from the index hospitalization, but were similar to that seen for beneficiaries in MS-DRG 194 after day 30. These two figures highlight differences in longer term utilization patterns for beneficiaries with different types of index diagnoses.

Figure 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"

Figure 10.    

Figure 10 reports the mean acute, PAC, and physician payments per PAC Users following discharge from an acute hospital-initiating event for MS-DRG 470 "Major joint replacement or reattachment of lower extremity w/o MCC", by type of claim (HHA, IRF, LTCH, SNF, readmission, hospital outpatient therapy, independent therapy and physician services) for each of the twenty-four 30-day windows included in the longitudinal cohort analysis.

Note: All initiating events occurred in 2006. Twenty-four 30-day windows were constructed following discharge from the initiating event to follow service use for 2 years.
Source: RTI analysis of 2006, 2007, and 2008 Medicare claims (M3MM181).

Figure 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"

Figure 11.    

Figure 11 reports the mean acute, PAC, and physician payments per PAC Users following discharge from an acute hospital-initiating event for MS-DRG 194 "Simple pneumonia & pleurisy w CC", by type of claim (HHA, IRF, LTCH, SNF, readmission, hospital outpatient therapy, independent therapy and physician services) for each of the twenty-four 30-day windows included in the longitudinal cohort analysis.

Note: All initiating events occurred in 2006. Twenty-four 30-day windows were constructed following discharge from the initiating event to follow service use for 2 years.
Source: RTI analysis of 2006, 2007, and 2008 Medicare claims (M3MM181).

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