1 Inpatient acute claims included both prospective payment system (PPS) and critical access hospital (CAH) claims.
Commonwealth Fund. A Path to a High Performance U.S. Health System: A 2020 Vision and the Policies to Pave the Way, February 2009. Retrieved July 2009 from http://www.commonwealthfund.org/~/media/Files/Publications/Fund Report/2009/Feb/The Path to a High Performance US Health System/1237_Commission_path_high_perform_US_hlt_sys_WEB_rev_03052009.pd
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 m
The analyses presented in this report demonstrate the effects of alternative episode definitions in terms of episode costs and composition. In summary, varying the episode definition affects
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 paym
Table 1 gives an overview of Medicare payments for index acute admissions and PAC episodes per index acute hospital discharge and per PAC user for each of the 18 alternative episode definitions included in our analysis. Mean index acute hospital payments were $8,287 per index acute hospital discharge versus $10,297 per PAC user. Index acute hospit
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,
In this analysis, we explore differences in the composition of PAC episodes using 18 different episode definitions. These episode definitions fall into two broad categories: fixed episodes and variable length episodes. Fixed episodes are calculated based on claims that occur within fixed windows of time following index acute hospital discharge. Ou
The initiating event for a PAC episode in our analysis is an index acute hospital stay in 2006. We define an index acute hospital stay as an acute hospital admission following a 60 day period without the use of acute, LTCH, IRF, SNF, or HHA services. Therefore, although all index acute hospitalizations took place in 2006, we also used data from th
The primary data source for this study was 2006 Medicare claims data. These data provided information on utilization and Medicare payments associated with acute hospital discharges and subsequent PAC. The 2006 Medicare claims files were used to track patterns of PAC use, including PAC service mix, length of stay, payment, and acute hospital readmi
In 2008, the Medicare program spent $49.9 billion on post-acute care (PAC) services including skilled nursing facilities (SNFs), home health agencies (HHAs), inpatient rehabilitation facilities (IRFs), and long-term care acute hospitals (LTCHs) (Medicare Payment Advisory Committee [MedPAC], 2009). This represents an increase of 8 percent over 2007
Final Report Prepared for Susan Bogasky Assistant Secretary for Planning and Evaluation (ASPE) U.S. Department of Health and Human Services Hubert H. Humphrey Building, Room 443F5 200 Independence Avenue, SW Washington, DC 20201 Prepared by
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Footnotes
1 Public Law 109-171, February 8, 2006 2 Public Law 110-275, July 15, 2008 3 Medicare severity diagnostic related groups 4 Prospective payment system 5 Relative value unit 6 Ambulatory payment classification 7 Electroconvulsive therapy 8 Healthcare common procedures coding system 9 Disproportionate share 10 Gr
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. References
Abt Associates Inc. (1997). Medicare Cataract Surgery Alternate Payment Demonstration: Final Evaluation Report . Cambridge, M.A. American Geriatrics Society (AGS) (2007). "Improving the Quality of Transitional Care for Persons with Complex Care Needs: American Geriatrics Society Position Statement." Assited Living Consult March/April: 30-32.
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Appendix F. Defining Professional Costs and Evaluation and Management (E&M) Visits
Defining Professional Claims for the Purposes of Attribution Under a narrow definition professional services are care directly rendered by a physician or related provider. This definition therefore excludes pharmacy, facility, and direct medical equipment. Broader definitions might include these services.
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Appendix E. Settings Involved in Episodes, by Condition and Measures Reported to Medicare Reporting Programs
(as of 12/08/2008, includes measures for 2009 reporting) Figure E1. Settings Involved in Episodes: AMI (MEGS)