Using Medicare Cost Reports to Calculate Costs for Post-Acute Care Claims

Coomer, Nicole; Ingber, Melvin J.; Daras, Laura Coots; Morley, Melissa

doi:10.3768/rtipress.2017.op.0036.1701

Cited by 3 publications

(7 citation statements)

References 3 publications

(3 reference statements)

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“…As Medicare Cost Reports are based on provider self‐reports, figures could be inflated or otherwise inaccurate. However, home health agencies must submit cost reports for review and approval by a Medicare Administrative Contractor and include supporting financial statements prepared by a Certified Public Accountant 25,33 . Additionally, as reports are made at the agency‐level and apply to all patients, inaccuracies would be unlikely to impact findings regarding observed differences by patient cognitive function.…”

Section: Discussionmentioning

confidence: 99%

“…Care delivery costs were calculated separately for each of the four visit types noted above, then summed together for total episodic care delivery cost. This approach is used in existing literature 18,32,33 and by CMS 34 . We modeled care delivery costs across three different time horizons—the first 30, 60, and 120 days following the start of care—to reflect the current 30‐day payment period for home health reimbursement, which was implemented in 2020, 35 the 60‐day payment period during our study timeframe, and the current 120‐day average duration of home health for Medicare beneficiaries 36…”

Section: Methodsmentioning

confidence: 99%

“…Per-visit care delivery costs are drawn from Medicare Cost Reports, which present unique strengths and limitations. These reports have been used in previous analyses of home health agency care delivery costs 18,32,33 and are the only source of national data on Medicare-certified provider costs. Cost reports may offer a more accurate measure of provider costs than payment data as they are not subject to policy adjustments 33 (e.g., adjustments to reimbursement based on a providers' performance on quality metrics).…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Patient cognitive impairment associated with higher home health care delivery costs

Burgdorf

Sen

Wolff

2022

Health Services Research

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Objective: To assess whether home health agencies incur significantly higher care delivery costs for patients with cognitive impairment across three timeframes relevant to home health payment policy. Data Sources: Linked Medicare home health claims and patient assessments, National Health and Aging Trends Study (NHATS), and home health agency cost reports for a nationally representative sample of Medicare beneficiaries receiving home health between 2011 and 2016. Study Design: We modeled care delivery costs incurred by the home health agency as a function of patient cognitive impairment using multivariable, propensity score-adjusted, generalized linear models. Data Collection/Extraction Methods: We identified NHATS participants who experienced an index home health episode between 2011 and 2016 (n = 1214; weighted n = 5,856,333) and linked their NHATS survey data to standardized patient assessment and claims data for the episode, as well as cost report data for the home health agency that provided care.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

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Patient cognitive impairment associated with higher home health care delivery costs

Burgdorf

Sen

Wolff

2022

Health Services Research

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“…Specific type of costs is discussed in detail below. Institutional charges were transformed to costs using institution‐specific cost‐to‐charge ratios for procedures associated with PBPC mobilization (eg, drug administration/observation cost, outpatient clinic visit, CD34 monitoring, plasma reduction) and collection (eg, collection procedure, platelet transfusion, cell processing and cryopreservation) 12,13 . Transformed costs were inflated from year of service to 2018 US dollar amounts using the medical component of the consumer price index 14 .…”

Section: Methodsmentioning

confidence: 99%

Cost saving, patient centered algorithm for progenitor cell mobilization for autologous hematopoietic cell transplantation

Sanikommu

Reese

et al. 2021

J of Clinical Apheresis

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Administration of plerixafor with granulocyte‐colony stimulating factor (G‐CSF) mobilizes CD34+ cells much more effectively than G‐CSF alone, but cost generally limits plerixafor use to patients at high risk of insufficient CD34+ cell collection based on low peripheral blood (PB) CD34+ counts following 4 days of G‐CSF. We analyzed costs associated with administering plerixafor to patients with higher day 4 CD34+ cell counts to decrease apheresis days and explored the use of a fixed split dose of plerixafor instead of weight‐based dosing. We analyzed 235 patients with plasma cell disorders or non‐Hodgkin's lymphoma who underwent progenitor cell mobilization and autologous hematopoietic cell transplantation (AHCT) between March 2014 and December 2017. Two hundred ten (89%) received G‐CSF plus Plerixafor and 25 (11%) received G‐CSF alone. Overall, 180 patients (77%) collected in 1 day, 53 (22%) in 2 days and 2 (1%) in 3 days. Based on our data, we present a probabilistic algorithm to identify patients likely to require more than one day of collection using G‐CSF alone. CD34+ cell yield, ANC and platelet recovery were not significantly different between fixed and standard dose plerixafor. Plerixafor enabled collection in 1 day and with estimated savings of $5000, compared to patients who did not receive plerixafor and required collection for three days. While collection and processing costs and patient populations vary among institutions, our results suggest re‐evaluation of current algorithms.

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“…Other missing data for model variables led to dropping an additional 108 SNFs. Finally, observations containing the top and bottom 1% of operating margin values were trimmed from the data set to remove outliers (342 SNFs) (Coomer et al, 2017). The final panel of SNFs included 7,782 facilities with annual observations for 2011-2016.…”

Section: Datamentioning

confidence: 99%

Is Skilled Nursing Facility Financial Status Related to Readmission Rate Improvement?

Clément¹,

MacDonald²

2022

Journal of Healthcare Management

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Goal:We examined whether higher skilled nursing facility (SNF) lagged profitability is associated with a lower 30-day all-cause all-payer risk-adjusted hospital readmission rate. Our aim was to provide insight into whether SNFs with limited financial resources are able to respond to incentives to lower their readmission rates to hospitals. Methods:We used data from 2012-2016 to estimate a fixed effects (FE) model with a time trend. Our data included financial data from the Centers for Medicare & Medicaid Services Healthcare Cost Report Information System SNF cost reports, facility characteristics including the all-cause all-payer risk-adjusted unplanned 30-day readmission rate from the LTCFocus (Long-Term Care Focus) project at Brown University, and county-level market variables from the Area Health Resource File. We also examined the relationship for a shorter time frame (2012)(2013)(2014)(2015) after stratifying the sample by system membership or ownership.Principal Findings: SNFs with an increase in the lagged operating margin showed a statistically significant, small decrease (<.01 percentage point) in the risk-adjusted readmission rate. The results were robust for different time periods and model specifications. Fixed effects model estimates for SNFs in the highest quartile of percentage of Medicaid patients (≥73.9%) had a lagged operating margin coefficient that is almost four times as large as the coefficient of the FE model with all SNFs.Application to Practice: SNFs have an important role in achieving the national priority of reducing hospital readmissions. The study findings suggest that managers of SNFs should not see low profitability as an obstacle to reducing readmission rates, which is good news

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Using Medicare Cost Reports to Calculate Costs for Post-Acute Care Claims

Cited by 3 publications

References 3 publications

Patient cognitive impairment associated with higher home health care delivery costs

Patient cognitive impairment associated with higher home health care delivery costs

Cost saving, patient centered algorithm for progenitor cell mobilization for autologous hematopoietic cell transplantation

Is Skilled Nursing Facility Financial Status Related to Readmission Rate Improvement?

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