Post Acute Care Episodes. Geographic Benchmarking Analysis

11/01/2009

The goal of the geographic benchmarking analysis is to look at the differences in PAC payments across different levels of geography to learn more about differences in patterns of PAC utilization as they relate to differences in the local availability of providers and practice patterns across the country. Analyses were conducted at national, state, and CBSA levels. Mean PAC payments and percentiles of PAC payments were calculated per index acute hospital discharge and per PAC user.

In conducting the geographic benchmarking analysis, we standardized payments to remove the effects of payment adjustments caused by geography or other policy considerations. By standardizing the payments, we remove payments related to wage adjustments, IME, and DSH payments. Our approach to standardizing payments included using base rate payments and case-mix weights as published in the Federal Register and applying those to our claims using the case-mix weight variables in the standard analytic files. We applied rates and weights according to the payment policies in place for each payment system corresponding to the type of PAC service and the claim date. The methods used to standardize payments were:

  • Acute hospital standardized payment = base rate * DRG weight
  • IRF standardized payment = base rate * case-mix group (CMG) weight
  • LTCH standardized payment = base rate * LTCH DRG weight
  • HHA standardized payment = base rate * home health resource group (HHRG) weight
  • SNF standardized payment = per diem * resource utilization group (RUG) weight * days
  • Hospital outpatient therapy standardized payment = physician fee schedule amount2 * units
Table 1. Medicare PAC Episode Payments per Index Acute Hospital Discharge and per PAC User, by Episode Definition
 

Per Index Acute Hospital Discharge1

(N = 310,629)

Per PAC User2

(N = 109,236)

Episode Definition Mean Index Acute Hospital Payment Mean Physician Payment During Index Acute Hospital3 Mean PAC Payment4 Mean Index Acute Hospital + PAC Payment5 Mean Total Episode Payment6 Mean Index Acute Hospital Payment Mean Physician Payment During Index Acute Hospital3 Mean PAC Payment4 Mean Index Acute Hospital + PAC Payment5 Mean Total Episode Payment6
A. 30 Day Fixed: Any Claim Starting within 30 Days after Hospital Discharge $8,287 $1,117 $4,592 $12,879 $13,996 $10,297 $1,531 $9,907 $20,205 $21,735
B. 30 Day Fixed: Any Claim Starting within 30 Days after Hospital Discharge Excluding Acute Hospital Readmissions $8,287 $1,117 $2,717 $11,004 $12,121 $10,297 $1,531 $7,591 $17,888 $19,419
C. 30 Day Fixed Following Hospital Discharge (prorated) $8,287 $1,117 $3,585 $11,872 $12,989 $10,297 $1,531 $7,576 $17,873 $19,404
D. 30 Day Fixed Following Hospital Discharge (prorated) Excluding Acute Hospital Readmissions $8,287 $1,117 $2,066 $10,354 $11,471 $10,297 $1,531 $5,819 $16,116 $17,647
E. 60 Day Fixed: Any Claim Starting within 60 Days after Hospital Discharge $8,287 $1,117 $6,020 $14,307 $15,424 $10,297 $1,531 $11,827 $22,124 $23,655
F. 60 Day Fixed: Any Claim Starting within 60 Days after Hospital Discharge Excluding Acute Hospital Readmissions $8,287 $1,117 $2,847 $11,134 $12,252 $10,297 $1,531 $7,885 $18,182 $19,713
G. 60 Day Fixed Following Hospital Discharge (prorated) $8,287 $1,117 $5,451 $13,738 $14,856 $10,297 $1,531 $10,703 $21,000 $22,531
H. 60 Day Fixed Following Hospital Discharge (prorated) Excluding Acute Hospital Readmissions $8,287 $1,117 $2,592 $10,879 $11,996 $10,297 $1,531 $7,216 $17,513 $19,043
I. 90 Day Fixed: Any Claim Starting within 90 Days after Hospital Discharge $8,287 $1,117 $7,063 $15,350 $16,467 $10,297 $1,531 $13,300 $23,598 $25,128
J. 90 Day Fixed: Any Claim Starting within 90 Days after Hospital Discharge Excluding Acute Hospital Readmissions $8,287 $1,117 $2,936 $11,223 $12,340 $10,297 $1,531 $8,092 $18,389 $19,920
K. 90 Day Fixed Following Hospital Discharge (prorated) $8,287 $1,117 $6,728 $15,015 $16,133 $10,297 $1,531 $12,661 $22,958 $24,489
This is a table showing Medicare PAC Episode Payments per Index Acute Hospital Discharge and per PAC User, by Episode Definition.

 

Table 1. Medicare PAC Episode Payments, per Index Acute Hospital Discharge and per PAC User by Episode Definition (continued)
 

Per Index Acute Hospital Discharge1

(N = 310,629)

Per PAC User2

(N = 109,236)

Episode Definition Mean Index Acute Hospital Payment Mean Physician Payment During Index Acute Hospital3 Mean PAC Payment4 Mean Index Acute Hospital + PAC Payment5 Mean Total Episode Payment 6 Mean Index Acute Hospital Payment Mean Physician Payment During Index Acute Hospital3 Mean PAC Payment4 Mean Index Acute Hospital + PAC Payment5 Mean Total Episode Payment6
L. 90 Day Fixed Following Hospital Discharge (prorated) Excluding Acute Hospital Readmissions $8,287 $1,117 $2,812 $11,099 $12,216 $10,297 $1,531 $7,774 $18,071 $19,602
M. 30 Day Variable Length Episode $8,287 $1,117 $6,522 $14,809 $15,926 $10,297 $1,531 $14,348 $24,645 $26,175
N. 30 Day Variable Length Episode Excluding Acute Hospital Readmissions $8,287 $1,117 $2,958 $11,246 $12,363 $10,297 $1,531 $8,256 $18,553 $20,084
O. 45 Day Variable Length Episode $8,287 $1,117 $7,267 $15,554 $16,672 $10,297 $1,531 $15,269 $25,566 $27,097
P. 45 Day Variable Length Episode Excluding Acute Hospital Readmissions $8,287 $1,117 $2,990 $11,277 $12,395 $10,297 $1,531 $8,301 $18,598 $20,129
Q. 60 Day Variable Length Episode $8,287 $1,117 $7,844 $16,131 $17,248 $10,297 $1,531 $16,058 $26,355 $27,886
R. 60 Day Variable Length Episode Excluding Acute Hospital Readmissions $8,287 $1,117 $3,013 $11,300 $12,417 $10,297 $1,531 $8,337 $18,635 $20,165

NOTES:

  1. Index acute hospitalizations are defined as hospital admissions following a 60 day period without acute, LTCH, SNF, IRF, or HHA service use. Note that per hospital discharge calculations include use of acute and PAC services for beneficiaries who do not meet the criteria of PAC user (use of institutional PAC service within 5 days of acute discharge or HHA or hospital outpatient therapy within 14 days of acute hospital discharge). This includes acute hospital readmissions for non-PAC users.
  2. PAC users are defined as beneficiaries discharged to SNFs, IRFs, or LTCHs within 5 days of discharge from an index acute hospitalization or who are discharged to HHAs or hospital outpatient therapy within 14 days of discharge from an index acute hospitalization. An index acute hospitalization is defined as a hospital admission following a 60 day period without acute, LTCH, SNF, IRF, or HHA service use.
  3. Physician services are defined as separately billable Part B physician services rendered during the acute hospital stay.
  4. PAC includes Medicare payments for SNF, IRF, LTCH, HHA, and hospital outpatient therapy. Note that acute hospital readmissions are also included in PAC payments for episode definitions A, C, E, G, I, K, M, O, and Q.
  5. Mean Index Acute Hospital + PAC Payment includes index acute hospital payment and PAC payment.
  6. Total episode payment includes index acute hospital, physician services during the index acute hospital stay, and PAC.
  7. Total payments columns may not equal the sum of components reported here because of rounding to the nearest dollar.

SOURCE: RTI Analysis of 2006 Medicare claims 5% sample (MM2Y234)

Continuation of table showing Medicare PAC Episode Payments per Index Acute Hospital Discharge and per PAC User, by Episode Definition.

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