Medicare Post-Acute Care Episodes and Payment Bundling

Morley, Melissa; Bogasky, Susan; Gage, Barbara; Flood, Shannon; Ingber, Melvin J.

doi:10.5600/mmrr.004.01.b02

Cited by 32 publications

(16 citation statements)

References 2 publications

(1 reference statement)

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“…[23] This may explain, in part, why only 2% of hospitalized CMC with Medicaid used post-acute care (as we noted), compared with nearly 40% of high-cost, hospitalized Medicare beneficiaries. [24] From 2001 to 2011, Medicare beneficiaries experienced a remarkable reduction in spending on hospital care (38% to 24%) as spending increased for home health care and post-acute care. [25] Further assessment is needed of the child and family benefits that could result from increased access and use of home health care and post-acute care.…”

Section: Discussionmentioning

confidence: 99%

Children With Medical Complexity And Medicaid: Spending And Cost Savings

et al. 2014

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A small but growing population of children with medical complexity (CMC), often covered by Medicaid, consumes a high proportion of pediatric healthcare spending. In this article, we first describe the expenditures of CMC with Medicaid across the care continuum. We report the increasingly large amount of spending on hospital care for CMC relative to the small amount of primary care and home care spending. We then present a business case that 1) estimates how cost savings might be achieved for CMC from reductions in potentially reducible hospital and emergency department use and 2) shows how the savings could underwrite investments in outpatient and community care. We conclude by discussing the importance of these findings in the context of Medicaid quality of care and healthcare reform.

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Section: Discussionmentioning

confidence: 99%

Children With Medical Complexity And Medicaid: Spending And Cost Savings

et al. 2014

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“…27 In Taiwan, all healthcare providers, including hospitals, follow a prospective FFS payment system. In 2002, after the implementation of Global Budget capitation system, hospitals share a limited budget and thus rigorously compete to increase their market share.…”

Section: Discussionmentioning

confidence: 99%

The Associations of Hospital Volume, Surgeon Volume, and Surgeon Experience with Complications and 30-Day Rehospitalization after Free Tissue Transfer: A National Population Study

Mahmoudi

Chang

et al. 2017

Plastic &Amp; Reconstructive Surgery

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Background Greater provider volume is associated with better outcomes. There is, however, a paucity of evidence on volume-outcome associations for surgical complications and 30-day all-cause rehospitalization after free tissue transfer (FTT) or free flap. Surgical complications and frequent rehospitalization are important quality indicators that substantially hinder appropriate healthcare spending. We hypothesized that increased provider volume and surgeon experience are associated with lower complication and hospital readmission rates. Methods We conduct a retrospective cohort study of adults 18–64 years of age who underwent FTT. We examined 100% of all FTT operations between 2001 and 2012 using Taiwan’s national data. We used regression modeling to examine associations between volume and outcome. All of our models were adjusted for patient, surgeon, and hospital characteristics. Results Seventeen percent of FTT operations (4,201 out of 25,327) had complications. Infection was the most prevalent complication after FTT (70%) and 30-day rehospitalization rate was about 20%. Hospital volume was associated with small decrease in complications in FTT (OR=0.99; CI:0.99–0.99; p < 0.01). For surgeons, years of experience and not annual case volume decreased surgical complications (OR=0.98; CI=0.97–0.99; p=0.01). We did not find any association between hospital or surgeon volume, or surgeon’s years of experience and 30-day rehospitalization. Conclusions Higher-volume hospitals and more experienced surgeons were shown to have lower likelihood of complications after surgery. Hospital process and structure affect outcomes and reduce surgical complications. Reducing a 30-day rehospitalization may require a payment reform as it demands a coordinated care pre and post hospital discharge.

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“…“Rehabilitation-based discharge destinations” included Medicare-designated post-acute care services provided in skilled nursing facilities (including swing bed units, SNF), inpatient rehabilitation facilities (IRF), and by home health agencies (Morley et al, 2014). Long-term acute hospitals were not classified as a rehabilitation-based service because care is more akin to an acute hospital than acute rehabilitation provided in IRFs.…”

Section: Methodsmentioning

confidence: 99%

The association of discharge destination with 30-day rehospitalization rates among older adults receiving lumbar spinal fusion surgery

Cook

Coronado

Bettger

et al. 2018

Musculoskeletal Science and Practice

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Background: As defined by Medicare (United States), post-acute rehabilitation services include care provided in inpatient rehabilitation units and facilities, skilled nursing facilities, long-term acute hospitals, and by home health services. Methods: We retrospectively evaluated the use of rehabilitation-based post-acute services among Medicare beneficiaries who were hospitalized for lumbar spinal fusion (ICD-9-CM procedure codes 81.04–81.08) in 2012–2014, examined the case-mix for those discharged to rehabilitation- and non-rehabilitation based services, and determined the association between these categories of discharge disposition and 30-day rehospitalization. The independent effect of rehabilitation-based discharge destination on 30-day readmissions was examined with a generalized linear mixed model, first adjusting for patient characteristics and then stratified by clusters that delineated more homogenous clinical profiles. Results: Among 261,558 Medicare beneficiaries with lumbar spinal fusion surgery, 50.8% were discharged to a rehabilitation-based post-acute services. Patients discharged to rehabilitation-based services were older and had more comorbidities, and had longer hospital lengths of stays. After adjusting for patient and hospital characteristics, patients discharged to rehabilitation-based post-acute care had increased odds of 30-day rehospitalization than those without discharge to other destinations (OR 1.36; 95%CI=1.31, 1.40). Analysis of patients by clinical profile clusters found similar results. Conclusions: Clinical profiles of Medicare beneficiaries who had lumbar spinal fusion surgery and were discharged to rehabilitation-based post-acute services included more comorbidities than those discharged to non-rehabilitation based settings. Controlling for these differences did not mediate the negative association between use of rehabilitation-based post-acute services and 30-day readmission.

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Medicare Post-Acute Care Episodes and Payment Bundling

Cited by 32 publications

References 2 publications

Children With Medical Complexity And Medicaid: Spending And Cost Savings

Children With Medical Complexity And Medicaid: Spending And Cost Savings

The Associations of Hospital Volume, Surgeon Volume, and Surgeon Experience with Complications and 30-Day Rehospitalization after Free Tissue Transfer: A National Population Study

The association of discharge destination with 30-day rehospitalization rates among older adults receiving lumbar spinal fusion surgery

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