scholarly journals Preferred Post‐Acute Care Providers in Bundled Payment: Implications for Patient Choice

2019 ◽  
Vol 67 (5) ◽  
pp. 1020-1022
Author(s):  
Peter J. Huckfeldt ◽  
Lianna Weissblum
Keyword(s):  
Acute Care ◽  
Patient Choice ◽  
Care Providers ◽  
Bundled Payment ◽  
Post Acute Care

The Effect of Hospital Safety Net Status on the Association Between Bundled Payment Participation and Changes in Medical Episode Outcomes

2021 ◽  
Author(s):  
Joshua M Liao ◽  
Paula Chatterjee ◽  
Erkuan Wang ◽  
John Connolly ◽  
Jingsan Zhu ◽  
...  
Keyword(s):  
Acute Care ◽  
Low Income ◽  
Safety Net ◽  
Care Utilization ◽  
Difference In Differences ◽  
Bundled Payment ◽  
Hospital Safety ◽  
Percentage Points ◽  
Acute Care Utilization ◽  
Post Acute Care

BACKGROUND: Under Medicare’s Bundled Payments for Care Improvement (BPCI) program, hospitals have maintained quality and achieved savings for medical conditions. However, safety net hospitals may perform differently owing to financial constraints and organizational challenges. OBJECTIVE: To evaluate whether hospital safety net status affected the association between bundled payment participation and medical episode outcomes. DESIGN, SETTING, AND PARTICIPANTS: This observational difference-in-differences analysis was conducted in safety net and non–safety net hospitals participating in BPCI for medical episodes (BPCI hospitals) using data from 2011-2016 Medicare fee-for-service beneficiaries hospitalized for acute myocardial infarction, pneumonia, congestive heart failure, and chronic obstructive pulmonary disease. EXPOSURE(S): Hospital BPCI participation and safety net status. MAIN OUTCOME(S) AND MEASURE(S): The primary outcome was postdischarge spending. Secondary outcomes included quality and post–acute care utilization measures. RESULTS: Our sample consisted of 803 safety net and 2263 non–safety net hospitals. Safety net hospitals were larger and located in areas with more low-income individuals than non–safety net hospitals. Among BPCI hospitals, safety net status was not associated with differential postdischarge spending (adjusted difference-in-differences [aDID], $40; 95% CI, –$254 to $335; P = .79) or quality (mortality, readmissions). However, BPCI safety net hospitals had differentially greater discharge to institutional post–acute care (aDID, 1.06 percentage points; 95% CI, 0.37-1.76; P = .003) and lower discharge home with home health (aDID, –1.15 percentage points; 95% CI, –1.73 to –0.58; P < .001) than BPCI non–safety net hospitals. CONCLUSIONS: Under medical condition bundles, safety net hospitals perform differently from other hospitals in terms of post–acute care utilization, but not spending. Policymakers could support safety net hospitals and consider safety net status when evaluating bundled payment programs.

scholarly journals Association Between Medicare’s Mandatory Joint Replacement Bundled Payment Program and Post–Acute Care Use in Medicare Advantage

JAMA Surgery ◽  
2020 ◽  
Vol 155 (1) ◽  
pp. 82 ◽  
Author(s):  
Andrew D. Wilcock ◽  
Michael L. Barnett ◽  
J. Michael McWilliams ◽  
David C. Grabowski ◽  
Ateev Mehrotra
Keyword(s):  
Acute Care ◽  
Joint Replacement ◽  
Medicare Advantage ◽  
Bundled Payment ◽  
Post Acute Care

Health Care Use Before and After Entering Long-Term Services and Supports

2016 ◽  
Vol 37 (1) ◽  
pp. 26-40 ◽  
Author(s):  
Robert Newcomer ◽  
Charlene Harrington ◽  
Denis Hulett ◽  
Taewoon Kang ◽  
Michelle Ko ◽  
...  
Keyword(s):  
Health Care ◽  
Acute Care ◽  
Long Term Care ◽  
Health Care Use ◽  
Care Providers ◽  
Term Care ◽  
Before And After ◽  
Ed Visits ◽  
Post Acute Care

Objective: We examined the health care utilization patterns of Medicare and Medicaid enrollees (MMEs) before and after initiating long-term care in the community or after admission to a nursing facility (NF). Method: We used administrative data to compare hospitalizations, emergency department (ED) visits, and post-acute care use of MMEs receiving long-term care in California in 2006-2007. Results: MMEs admitted to a NF for long-term care had much greater use of hospitalizations, ED visits, and post-acute care before initiating long-term care than those entering long-term care in the community. Post-entry, community service users had less than half the average monthly hospital and ED use compared with the NF cohort. Conclusion: Hospital and ED use prior to and following NF and personal care program entry suggest a need for reassessing the monitoring of these high-risk populations and the communication between health and community care providers.

scholarly journals Preparing for the Future of Post–Acute Care: A Metasynthesis of Qualitative Studies

2016 ◽  
Vol 29 (2) ◽  
pp. 70-80
Author(s):  
Allison M. Gustavson ◽  
Jacqueline Jones ◽  
Kelly J. Morrow ◽  
Jennifer E. Stevens-Lapsley
Keyword(s):  
Older Adults ◽  
Quality Of Care ◽  
Acute Care ◽  
Professional Education ◽  
Practice Patterns ◽  
Clinical Care ◽  
Future Research ◽  
Care Providers ◽  
Post Acute Care

Despite poor outcomes for older adults following hospitalization, practice patterns of post–acute care clinicians and factors impacting quality of care are not well studied, which limits advancements in clinical care. Qualitative research on the factors that influence physician practice patterns with respect to older adults has been studied and may provide a framework for hypothesizing factors relevant to other post–acute care clinicians. Three themes emerged from this qualitative metasynthesis: (1) Current medical education and clinical guidelines are not aligned with the multifaceted care needed for older adults, (2) communication gaps impact quality of care, and (3) health policies constrain quality of care. Identifying potential factors that impact practice patterns in post-acute care providers may guide future research initiatives that shape health professional education and system policies.

scholarly journals Variation in expenditure for common, high cost surgical procedures in a working age population: implications for reimbursement reform

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
W. Wynn-Jones ◽  
T. P. Koehlmoos ◽  
C. Tompkins ◽  
A. Navathe ◽  
S. Lipsitz ◽  
...  
Keyword(s):  
Acute Care ◽  
Knee Replacement ◽  
Surgical Procedures ◽  
Cost Of Care ◽  
Index Procedure ◽  
Bundled Payment ◽  
Bundled Payments ◽  
Working Age ◽  
Working Age Population ◽  
Post Acute Care

Abstract Background In the move toward value-based care, bundled payments are believed to reduce waste and improve coordination. Some commercial insurers have addressed this through the use of bundled payment, the provision of one fee for all care associated with a given index procedure. This system was pioneered by Medicare, using a population generally over 65 years of age, and despite its adoption by mainstream insurers, little is known of bundled payments’ ability to reduce variation or cost in a working-age population. This study uses a universally-insured, nationally-representative population of adults aged 18–65 to examine the effect of bundled payments for five high-cost surgical procedures which are known to vary widely in Medicare reimbursement: hip replacement, knee replacement, coronary artery bypass grafting (CABG), lumbar spinal fusion, and colectomy. Methods Five procedures conducted on adults aged 18–65 were identified from the TRICARE database from 2011 to 2014. A 90-day period from index procedure was used to determine episodes of associated post-acute care. Data was sorted by Zip code into hospital referral regions (HRR). Payments were determined from TRICARE reimbursement records, they were subsequently price standardized and adjusted for patient and surgical characteristics. Variation was assessed by stratifying the HRR into quintiles by spending for each index procedure. Results After adjusting for case mix, significant inter-quintile variation was observed for all procedures, with knee replacement showing the greatest variation in both index surgery (107%) and total cost of care (75%). Readmission was a driver of variation for colectomy and CABG, with absolute cost variation of $17,257 and $13,289 respectively. Other post-acute care spending was low overall (≤$1606, for CABG). Conclusions This study demonstrates significant regional variation in total spending for these procedures, but much lower spending for post-acute care than previously demonstrated by similar procedures in Medicare. Targeting post-acute care spending, a common approach taken by providers in bundled payment arrangements with Medicare, may be less fruitful in working aged populations.

Abstract TP309: Creating a Crystal Ball: Predicting Successful Rehabilitation for Optimal Discharge Placement

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
David Ermak ◽  
Raymond Reichwein ◽  
Alicia Richardson ◽  
Kathy Morrison ◽  
Travis Lehman
Keyword(s):  
Acute Care ◽  
Care Delivery ◽  
Skilled Nursing Facility ◽  
Retrospective Chart Review ◽  
Stroke Patients ◽  
Skilled Nursing ◽  
Bundled Payment ◽  
Successful Rehabilitation ◽  
Care Improvement ◽  
Post Acute Care

Introduction: In 2014, the Centers for Medicare and Medicaid Services (CMS) launched the Bundled Payment for Care Improvement (BPCI) program. Our institution is contracted for a 90 day stroke bundle, making us responsible for all Medicare stroke patient costs. Quarterly review of 2015 financial data (DRG 64 & 65) revealed a significant spend occurs in the post-acute care phase. Methods: Detailed analysis and sequencing revealed that of the 40% of patients discharged to an Inpatient Rehab Facility (IRF) 31% were unsuccessful in rehabilitation and instead transitioned to a Skilled Nursing Facility (SNF). Had SNF been initially selected, a cost avoidance of $292,650 would have been appreciated. Conclusion: Involvement in the BPCI program has provided insight into the post-acute care of stroke patients. With the advent of BPCI, institutions will be increasingly held fiscally responsible for post-acute care delivery. Ongoing retrospective chart review and collaboration with Physical Medicine and Rehabilitation colleagues is underway to identify key indicators that would project successful rehabilitation. Analysis will include comparison between those who were successfully discharged home after an IRF stay to those that needed a SNF after an IRF stay. This would provide inpatient teams with strategies for predicting the optimal discharge location for stroke patients.

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