Analysis of the Joint Distribution of Disproportionate Share Hospital Payments. Appendix A. Technical Documentation for Estimating DSH Payments
Data Sources Used to Estimate Medicare Payments...
Are Homeless Families Connected to the Social Safety Net?
New analysis of data from HUD's Family Options Study of families' experiences in shelter and 20 months later shows that families experiencing homelessness are generally connected to public benefits at similar rates to other families in deep poverty. This non-experimental analysis finds that homeless families receive TANF, publicly funded health i...
Health Care Spending Growth and Federal Policy
In this Issue Brief, we examine spending growth through 2014, the first year the Affordable Care Act’s coverage provisions were in effect, and 2015, where possible. We provide detailed cost growth trends for Medicare and the private insurance market. We also estimate the effect of recently introduced specialty drugs on current and future spendin...
Medicare Part B Drugs: Pricing and Incentives
Medicare Part B covers infusible and injectable drugs and biologics administered in physician offices and hospital outpatient departments; as well as certain other drugs required by law provided by suppliers such as pharmacies The Part B payment method provides weak incentives for physicians to consider value – that is choose the lowest cost the...
Examining Post Acute Care Relationships in an Integrated Hospital System. Footnotes
1 Medicare Benefit Policy Manual, Chapter 3 Duration of Covered Inpatient Services.
2 Medicare Benefit Policy Manual, Chapter 7 Home Health Services.
3 An index hospitalization is an acute hospitalization with a prior 60-day clean period. In the prior 60 days, no acute or post-acute (IRF, LTCH, SNF, HHA, outpatient therapy) services were...
Examining Post Acute Care Relationships in an Integrated Hospital System. Appendix B
Table B-1. Utilization 1 and Payment, by Claim Type, by DRG and APR-DRG Severity Index 2 , for Live Discharges, 2005
APR-DRG Severity of Illness Level
DRG
N
%
with
Claim
Mean
Use
Mean
Payment
N...
Examining Post Acute Care Relationships in an Integrated Hospital System. Appendix A
HHC
Label
HCC1
HIV/AIDS
HCC2
Septicemia/Shock
HCC5
Opportunistic Infections
HCC7
Metastatic Cancer and Acute Leukemia
HCC8
Lung, Upper Digestive Tract, and Other Severe Cancers...
Examining Post Acute Care Relationships in an Integrated Hospital System. 5. References
Berenson, R. 2004. The Medicare Chronic Improvement Program. Retrieved August 2008 from http://www.urban.org/publications/900714.html
Buntin MB, AD Garten, S Paddock, D Saliba, M Totten, and JJ Escarce. 2005. How much is postacute care use affected by its availability? Health Serv. Res., 40(2): 413-34.
CDC (Centers for Disease Control and P...
Examining Post Acute Care Relationships in an Integrated Hospital System. 4.2 Next Steps
The results of the current work will feed directly in to work we will be completing as part of a contract modification. The additional work will include use of the CCW data to identify the presence of chronic conditions in beneficiaries in our 2006 episode file. Similar to some of the analyses presented in this report, we will look at the patterns...
Examining Post Acute Care Relationships in an Integrated Hospital System. 4.1 Implications of the Findings
These analyses provide important information for understanding who uses PAC services, how their likelihood of using them differs by certain characteristics, and which factors are most important in predicting hospital length of stay, probability of PAC use, relative probability of PAC site of care choices, hospital readmission rates, and average ep...
Examining Post Acute Care Relationships in an Integrated Hospital System. 3.9.5 Ordinary Least Squares Regression Predicting Post-Acute Care Episode Payment
In the regression predicting PAC episode payments, increasing severity is associated with increases in episode payments. For example, in the model using MS-DRG severity measures and HCCs (Set 3, Table 3-27 ), beneficiaries with MS-DRG w/MCC have $6,313 higher episode payments compared to beneficiaries in the lowest severity level....
Examining Post Acute Care Relationships in an Integrated Hospital System. 3.9.4 Binomial Logit Regression Predicting Readmission During Post-Acute Care Episodes
As in the other models, severity is an important predictor of acute hospital readmission during PAC episodes. The odds of readmission increase with increasing severity. In the binomial logit model using both the MS-DRG severity measures and the HCCs (Set 3, Table 3-27 ), the odds of readmission for beneficiaries with MS-DRG w/MCC are 1.4 times t...
Examining Post Acute Care Relationships in an Integrated Hospital System. 3.9.3 Multinomial Logit Predicting First Site of Post-Acute Care
The effect of severity on first site of PAC demonstrates that the odds of discharge to IRFs, LTCHs, and SNFs are much higher compared to the odds of discharge to hospital outpatient therapy or home health for beneficiaries of higher severity. For example, in the multinomial model run using the APR-DRG severity measures (Set 1, Table 3-24 ), the...
Examining Post Acute Care Relationships in an Integrated Hospital System. 3.9.2 Binomial Logit Regression Predicting Use of Post-Acute Care
As in the model predicting index acute admission length stay, severity measures were important factors in predicting the use of any PAC services. The odds of using any post-acute care services increased with increasing severity level across each set of severity measures. In the case of APR-DRGs (Set 1, Table 3-24 ), for beneficiaries in APR-DRG...
