Post Acute Care Episodes

Final Report

Prepared for

Susan Bogasky
November 2009

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

Melissa Morley, PhD Barbara Gage, PhD Laura Smith, PhD Pamela Spain, PhD Melvin Ingber, PhD
RTI International 1440 Main Street–Suite 310 Waltham, MA 02451-1523
RTI Project Number: 0208824.002.003

RTI International is a trade name of Research Triangle Institute.

This report is available on the Internet at:
http://aspe.hhs.gov/health/reports/09/pacepifinal/index.shtml

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ABSTRACT

This purpose of this project is to continue the ASPE bundling research in the area of Medicare post acute care using the 2006 Medicare post acute episode file developed in the previous analysis. This project considers 18 alternative Medicare acute hospital plus post-acute care episode definitions, models the impact on potential payment bundles, and examines differences in payments by geographic area using standardized payments.

Table of Contents

Background

Post-acute Care Episode Definitions

• 2.1 Data Source
• 2.2 Episode Definitions
• Defining the Start of an Episode
• Alternative Episode Definitions
• Geographic Benchmarking Analysis

Results

• 3.1 Geographic Benchmarking Analysis

Discussion

• 4.1 Conclusions and Implications of the Findings
• 4.2 Next Steps

References

Table of Figures

Figure 1. Fixed versus Variable Length Episodes

Figure 2. Defining End Points of Fixed Episodes

Figure 3. PAC Payments per PAC User—30 Day Fixed Episode Definitions, All MS-DRGs

Figure 4. PAC Payments per PAC User—30 Day Fixed Episode Definitions, MS-DRG 470, Major Joint Replacement or Reattachment of Lower Extremity without Major Complication or Comorbidity

Figure 5. PAC Payments per PAC User—30 Day Fixed Episode Definitions, MS-DRG 194, Simple Pneumonia and Pleurisy with Complication or Comorbidity

Figure 6. PAC Payments per PAC User—30 Day Fixed, 60 Day Fixed, 90 Day Fixed, and 30 Day Variable Length Episode Definitions

Figure 7. PAC Payments per PAC User Excluding Readmissions—30 Day Fixed, 60 Day Fixed, 90 Day Fixed, and 30 Day Variable Length Episode Definitions

 

Tables

Table 1. Medicare PAC Episode Payments per Index Acute Hospital Discharge and per PAC User, by Episode Definition

Table 2. Medicare PAC Episode Payments and Utilization per PAC User, by Episode Definition

Table 3. Medicare PAC Episode Payments and Utilization for PAC Users, by Service Type, by Episode Definition

Table 4. Mean Payment per Service User, per PAC User, and per Index Acute Hospital Discharge, by 30 Day Episode Definition

Table 5. PAC Standardized Payments by State, Episode Definition A—30 Day Fixed: Any Claim Starting within 30 Days

Table 6. PAC Standardized Payments by CBSA, Episode Definition A—30 Day Fixed: Any Claim Starting within 30 Day

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Last Updated: 03/15/2010