Potentially Avoidable Hospitalizations of Dually Eligible Medicare and Medicaid Beneficiaries from Nursing Facility and Home‐ and Community‐Based Services Waiver Programs

Walsh, Edith; Wiener, Joshua M.; Haber, Susan; Bragg, Arnold; Freiman, Marc P.; Ouslander, Joseph G.

doi:10.1111/j.1532-5415.2012.03920.x

Cited by 198 publications

(246 citation statements)

References 18 publications

Supporting

Mentioning

238

Contrasting

Order By: Relevance

“…This study identified potentially avoidable hospitalizations using the same logic and diagnosis codes described in Walsh, Freiman, Haber, Bragg, Ouslander, & Wiener (2010). The algorithm was developed by a technical expert panel that was sponsored by the Centers for Medicare & Medicaid Services (CMS) and included experts in geriatrics, ambulatory care sensitive conditions, and other quality measures.…”

Section: Potentially Avoidable Hospitalization Algorithmmentioning

confidence: 99%

Medicare-Medicaid Eligible Beneficiaries and Potentially Avoidable Hospitalizations

Segal¹,

Rollins²,

Hodges³

et al. 2014

MMRR

View full text Add to dashboard Cite

Objective: Potentially avoidable hospitalizations have been identified by experts as leading to poor health outcomes and costly care. Potentially avoidable hospitalizations are particularly common among full-benefit dual eligible beneficiaries. This paper examines potentially avoidable hospitalizations rates by setting, state, and medical condition, and the average cost of these events.Methods: This analysis identifies potentially avoidable hospitalizations using diagnosis codes identified by an expert panel. Settings of care are determined using a timeline file, which assigns an individual to a specific setting on a particular day.

show abstract

Section: Potentially Avoidable Hospitalization Algorithmmentioning

confidence: 99%

Medicare-Medicaid Eligible Beneficiaries and Potentially Avoidable Hospitalizations

Segal¹,

Rollins²,

Hodges³

et al. 2014

MMRR

View full text Add to dashboard Cite

show abstract

“…These conditions considered as potentially preventable or manageable within the nursing home setting were developed by a technical expert panel in a study funded by CMS [32]. …”

Section: Incontinencementioning

confidence: 99%

“…Hospitalizations of nursing home residents are common. Research has suggested that 31-45% of these hospitalizations may be avoidable or manageable within the nursing facility with appropriate care [29][30][31][32]. In 2010, more than 90% of all certified facilities were cited for one or more deficiencies and nearly one-fourth of all certified facilities were cited for deficiencies that caused actual harm or immediate jeopardy to residents [9].…”

Section: Evidence Of Low Quality In Nursing Homes and Changes In Qualmentioning

confidence: 99%

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

Xing¹,

Mukamel²,

Glance³

et al. 2016

WHM

View full text Add to dashboard Cite

2013ii Biographical SketchThe author was born in Shanghai, China. She attended Shanghai Second Medical This dissertation provides evidence that linking Medicaid reimbursement rate to each NH's own expenditures and incentivizing NHs to invest in direct care were effective ways in achieving quality improvement. Refinements of current Medi-Cal reimbursement policy might be needed to encourage NHs to make larger investments. However, maximizing NHs' spending on direct care cannot be relied on as the only policy strategy to improve quality of care. vii Contributors and Funding SourcesThis work was supervised by a dissertation committee consisting of Professors

show abstract

“…Reducing HF hospital readmission rates from SNF and NH has become a national priority because approximately 20% of these patients are Medicare beneficiaries and are readmitted within 30 days [4]. Readmissions are multifactorial and problematic in this unique population because of high cost, and disruptions in care, disease progression, and increased mortality.…”

mentioning

confidence: 99%

“…In order to decrease costs, the National Quality Forum has endorsed hospital risk-standardized readmission rates (RSRRs) as performance measures [3]. The patient protection Affordable Care Act 2010 created incentives to reduce readmission, with penalties for hospitals which included zero reimbursement for services provided and/or loss of revenue if the HF patient is readmitted within 30 days [4]. Hospitals with high readmission rates may be subject to lose ~3% of their Medicare reimbursement by 2015 [3].…”

mentioning

confidence: 99%

Factors associated with heart failure readmissions from skilled nursing facilities

Ak¹

2017

Interventional-Cardiology

View full text Add to dashboard Cite

Background: Despite guideline-driven pharmacological therapies and careful transitional care, the rates of preventable hospital re-admission of heart failure patients and associated costs remain unacceptably high in the SNF populations. Transfer to SNF is one strategy to limit hospitalizations. As such, 25% of patients are still symptomatic at time of discharge.Purpose: The objective of this study is to identify patient factors affecting re-admissions of HF patients residing in SNF within 30-days.Methods: A retrospective electronic chart review was completed on patients > 65 years with HF who were admitted into large medical center between 2012 and 2014. Descriptive statistics and univariate analyses using the chi-square test or Fisher's exact test for categorical variables and the Mann-Whitney test for continuous data was used to compare patients readmitted within 30 days vs. those who were not readmitted within 30 days. Significant factors associated with readmission in the univariate analysis (p < 0.10) were included for a multivariate logistic regression model. The analysis of LOS was accomplished by applying standard methods of survival analysis, i.e., computing the Kaplan-Meier product limit curves, where the data were stratified by readmission within 30 days (Yes vs. No). No data were considered 'censored'. The groups were compared using the log-rank test. The median rates for each group were obtained from the Kaplan-Meier/Product-Limit Estimates and their corresponding 95% confidence intervals were computed, using Greenwood's formula to calculate the standard error. Unless otherwise specified, a result was considered statistically significant at the p < 0.05 level of significance.Results: Fifteen variables: creatinine, weight difference, CKD, Angina, Arrhythmia, VHD, Tobacco, ADL, independent in bathing, independent in the toilet, S3 Heart sounds present, HJR, AF, Nitrates, and Hydralazine, were identified for the multivariate logistic regression as potential risk factors associated with "readmission within 30 days". Based on 23 readmissions within 30 days, our final model included only 2 predictor variables. Creatinine and ADLs were included in the final model as this subset of predictors was found to be the best for prediction of "readmission within 30 days". Creatinine (p < 0.0087) and ADLs (p < 0.0077) were both significantly associated with readmission within 30 days in the final logistic regression model. Every 1-unit increase in creatinine was associated with an 87% increase in the odds of being readmitted within 30 days (OR = 1.87). Those patients who require assistance with ADLs were over 9 times more likely to be readmitted within 30 days (OR = 9.25) as compared to patients who are independent.

show abstract

Potentially Avoidable Hospitalizations of Dually Eligible Medicare and Medicaid Beneficiaries from Nursing Facility and Home‐ and Community‐Based Services Waiver Programs

Abstract: Potentially avoidable hospitalizations are common and costly in the dually eligible population. New initiatives are needed to reduce PAH in this population as they are costly and can adversely affect function and quality of life.

Cited by 198 publications

References 18 publications

Medicare-Medicaid Eligible Beneficiaries and Potentially Avoidable Hospitalizations

Medicare-Medicaid Eligible Beneficiaries and Potentially Avoidable Hospitalizations

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

Factors associated with heart failure readmissions from skilled nursing facilities

Contact Info

Product

Resources

About