Over the next year, ASPE and RTI will continue to work on episodes of care for Medicare beneficiaries. While past research has used only 2006 data, work in the coming year will create a longitudinal file using additional years of Medicare claims data. The data file will have the ability to follow Medicare beneficiaries across time to account for multiple episodes over time, rather than just the first episode per year. RTI will also increase the claims sample by using 30 percent Medicare data, allowing for greater statistical power at the MS-DRG level at different geographical levels. This project will analyze both hospital-initiated episodes and PAC episodes initiating in HHAs, IRFs, or LTCHs. This work will be important for understanding the implications of bundled payments for more chronic populations.
A second effort that ASPE and RTI have under way involves examining the landscape of formal and informal organizational relationships between acute care and PAC providers. This work will help us to understand the extent to which the health care communities create formal and informal delivery networks. Our analysis will build on our earlier work (Gage et al., 2009), examining the extent to which PAC use is affected by the hospital owning a PAC provider, having a hospital-based unit, or being a freestanding provider under common ownership with the hospital, as well as the differences between the chain-based PAC providers and those belonging to formal integrated delivery systems. The goal of this work will be to use CMS data sources and the PAC referral patterns observed in the claims data to learn more about existing formal and informal organizational relationships between PAC providers and the potential for providers to establish relationships under a bundled payment system. Both of these projects will highlight issues to consider that are related to the implementation of PAC bundled payment.
A third project that ASPE and RTI will work on over the next year explores methods to risk-adjust PAC episodes1. This work represents the next step in ASPE's work to learn more about episodes of PAC and potential bundled payment options. This work is also the next step in collaboration with CMS to inform PAC-PRD. In this project, RTI will construct episodes for beneficiary participants in PAC-PRD, using methodologies developed under previous phases of this collaboration. This phase of the collaboration will develop and model the impact of alternative risk adjusters for predicting payment and outcomes across episode-based bundled payment options using the Continuity Assessment Record and Evaluation (CARE) Tool variables, a uniform assessment instrument developed and collected in the PAC-PRD. Prediction models, episodes, and corresponding bundled payments will be constructed using CARE data from acute hospital discharges and PAC admissions.