Post Acute Care Episodes. 3.1 Geographic Benchmarking Analysis

11/01/2009

The results of the geographic benchmarking analysis demonstrate the variation in the percentage of beneficiaries using PAC services in different parts of the country as well as differences in utilization and payments for those who do use PAC. The results of the geographic analysis are presented in Tables 5 and 6. Table 5 presents standardized payments at the state level for Massachusetts, New York, Oregon, and Texas. Table 6 presents the standardized payments at the CBSA level for four CBSAs: Boston, Massachusetts; Rochester, New York; Portland, Oregon; and Dallas, Texas. Each of these states and CBSAs have participating providers in the CMS Post-Acute Care Payment Reform Demonstration (PAC-PRD) and were chosen based on geographic variation and differences practice patterns and supply of PAC providers.

There is significant variation in the percentage of beneficiaries discharged to PAC across geographic areas. Massachusetts can be characterized as a "high PAC" state due to the large supply of PAC providers per beneficiary population and the large supply of LTCH providers in the state. Table 5 shows that in Massachusetts, 49 percent of beneficiaries discharged from index acute hospital stays go on to use PAC compared with 30.2 percent in Oregon, which is characterized by a lower supply of PAC providers and lower PAC use in general.6 Mean PAC payments per PAC user were $8,003 in Massachusetts and $5,369 in Oregon indicating higher utilization of services within PAC episodes for PAC users in Massachusetts (mean episode length of stay of 40.5 days in Massachusetts compared with 33.5 days in Oregon). Corresponding mean PAC payments per hospital discharge were $4,601 in Massachusetts and $2,352 in Oregon, and this difference reflects both the lower proportion of discharges to PAC and the lower use of PAC among beneficiaries using PAC services in Oregon. The results for New York and Texas also provide valuable information on geographic variation. New York has very low LTCH utilization and no freestanding IRF providers. In contrast, Texas has a large supply of both of these types of providers. The results show that while PAC payments per PAC user were $7,756 in New York, PAC payments per PAC user were 41.8 percent higher in Texas ($10,999). Although mean PAC payments per PAC user differed significantly, mean PAC episode length of stay was similar in the two states (38.9 days in New York and 40.6 days in Texas), indicating significant differences in the types of services used during episodes of care of similar length.

Table 5. PAC Standardized Payments by State, Episode Definition A—30 Day Fixed: Any Claim Starting within 30 Days
  Massachusetts
49.0% of Index Acute Hospital
Discharges Using PAC
New York
39.4% of Index Acute Hospital
Discharges Using PAC
Percentile Mean PAC Payment per Hospital Discharge (N = 7,105) Mean PAC Payment per PAC User (N = 3,482) Mean PAC LOS1 per PAC User Mean PAC Payment per Hospital Discharge (N = 18,299) Mean PAC Payment per PAC User (N = 7,202) Mean PAC LOS per PAC User
95th $22,114 $29,090 84.0 $18,874 $25,672 90.0
90th $14,143 $20,798 74.0 $11,833 $19,649 71.0
75th $5,359 $9,670 57.0 $4,305 $9,764 53.0
50th $1,226 $4,347 37.0 $0 $4,203 33.0
25th $0 $1,910 22.0 $0 $1,910 19.0
Mean $4,601 $8,003 40.5 $3,823 $7,756 38.9

 

  Oregon
30.2% of Index Acute Hospital
Discharges Using PAC
Texas
29.2% of Index Acute Hospital
Discharges Using PAC
Percentile Mean PAC Payment per Hospital Discharge (N = 2,434) Mean PAC Payment per PAC User (N = 734) Mean PAC LOS per PAC User Mean PAC Payment Per Hospital Discharge (N = 21,325) Mean PAC Payment per PAC User (N = 6,233) Mean PAC LOS per PAC User
95th $12,018 $18,986 71.0 $23,351 $36,062 79.0
90th $6,856 $12,473 60.0 $13,587 $28,186 68.0
75th $2,316 $6,677 47.0 $4,502 $14,851 60.0
50th $0 $3,422 31.0 $0 $4,635 38.0
25th $0 $1,687 17.0 $0 $2,316 22.0
Mean $2,352 $5,369 33.5 $4,305 $10,999 40.6
1. LOS = length of stay.
This is a table showing PAC Standardized Payments by State, Episode Definition A—30 Day Fixed: Any Claim Starting within 30 Days.

Similar results can be seen at the CBSA level (Table 6). In Boston, 48.9 percent of beneficiaries were discharged to PAC compared with 33.0 percent in Portland. Mean PAC payments per PAC user were $8,168 in Boston and $5,598 in Portland. Mean PAC payments per PAC user in Boston were slightly higher than in Massachusetts overall, which may indicate differences in practice patterns and use of services in urban Boston compared with other parts of the state. Although the mean PAC payment per PAC user was lower in Rochester ($6,242) than in New York State overall ($7,756), the proportion of beneficiaries discharged to PAC was higher in Rochester (47.5 percent) compared with New York State overall (39.4 percent). Findings indicating differences between the CBSA level and the state level highlight the importance of understanding current PAC utilization patterns in different geographic areas when thinking about PAC payment reform options.

Table 6. PAC Standardized Payments by CBSA, Episode Definition A—30 Day Fixed: Any Claim Starting within 30 Days
  Boston, Massachusetts
48.9% of Index Acute Hospital
Discharges Using PAC
Rochester, New York
47.5% of Index Acute Hospital
Discharges Using PAC
 
Percentile Mean PAC Payment per Hospital Discharge (N = 4,840) Mean PAC Payment per PAC User (N = 2,369) Mean PAC LOS1 per PAC User Mean PAC Payment per Hospital Discharge (N = 790) Mean PAC Payment per PAC User (N = 375) Mean PAC LOS per PAC User
95th $22,526 $29,697 83.0 $16,348 $23,826 84.0
90th $13,733 $21,123 72.0 $9,393 $15,713 62.0
75th $5,429 $9,705 56.0 $4,252 $7,025 47.0
50th $1,446 $4,538 36.0 $222 $3,678 32.0
25th $0 $1,910 22.0 $0 $1,854 18.0
Mean $4,654 $8,168 39.9 $3,496 $6,242 36.5

 

  Portland, Oregon
33.0% of Index Acute Hospital
Discharges Using PAC
Dallas, Texas
29.4% of Index Acute Hospital
Discharges Using PAC
Percentile Mean PAC Payment per Hospital Discharge (N = 1,038) Mean PAC Payment per PAC User (N = 343) Mean PAC LOS per PAC User Mean PAC Payment per Hospital Discharge (N = 4,327) Mean PAC Payment per PAC User (N = 1,273) Mean PAC LOS per PAC User
95th $12,956 $21,776 68.0 $24,337 $35,500 80.0
90th $8,293 $15,002 60.0 $14,990 $27,917 69.0
75th $3,540 $6,378 43.0 $4,546 $16,676 60.0
50th $0 $3,918 31.0 $0 $5,025 37.0
25th $0 $1,743 19.0 $0 $3,356 23.0
Mean $2,512 $5,598 32.7 $4,460 $11,570 40.5
1. LOS = length of stay.
This is a table showing PAC Standardized Payments by CBSA, Episode Definition A—30 Day Fixed: Any Claim Starting within 30 Days.

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