scholarly journals Post–Acute Care Takes Center Stage in CMS (Centers for Medicare and Medicaid Services) Plan to Expand Use of Bundled Payments for Heart Attack

Circulation ◽  
2016 ◽  
Vol 134 (19) ◽  
pp. 1503-1504 ◽  
Author(s):  
Bridget M. Kuehn
Keyword(s):  
Acute Care ◽  
Heart Attack ◽  
Bundled Payments ◽  
Center Stage ◽  
Post Acute Care

Medicare Bundled Payments for Post-Acute Care: Characteristics and Baseline Performance of Participating Skilled Nursing Facilities

2018 ◽  
Vol 77 (2) ◽  
pp. 155-164 ◽  
Author(s):  
Xi Cen ◽  
Helena Temkin-Greener ◽  
Yue Li
Keyword(s):  
Acute Care ◽  
Market Competition ◽  
Cost Of Care ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Bundled Payments ◽  
Baseline Performance ◽  
Care Improvement ◽  
Post Acute Care

Medicare bundled payment models have focused on post-acute care as a key component of improving the efficiency and quality of health care. This study investigated the characteristics and baseline performance of skilled nursing facilities (SNFs) that participated in Medicare Bundled Payments for Care Improvement Initiative Model 3. As of July 2016, 657 SNFs participated in 7,932 episodes in risk-bearing phase. Our retrospective analyses found that larger facilities, higher occupancy rate, chain affiliation, better five-star overall rating, and higher market competition for SNF care were associated with increased likelihood of enrolling in clinical episodes in Model 3, whereas not-for-profit ownership, higher adjusted staffing levels, higher percentage of Medicaid residents, and rural location were associated with reduced likelihood of participation in Bundled Payments for Care Improvement. Policy makers should consider approaches to encourage participation of post-acute care providers in this voluntary program and evaluate its impact on patient selection, cost of care, and health outcomes.

Post‐Acute Care After Joint Replacement in Medicare's Bundled Payments for Care Improvement Initiative

2019 ◽  
Vol 67 (5) ◽  
pp. 1027-1035 ◽  
Author(s):  
Karen E. Joynt Maddox ◽  
E. John Orav ◽  
Jie Zheng ◽  
Arnold M. Epstein
Keyword(s):  
Acute Care ◽  
Joint Replacement ◽  
Bundled Payments ◽  
Care Improvement ◽  
Post Acute Care

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.

New Post-Acute Care Quality Measures Take Effect Oct. 1

ASHA Leader ◽  
2016 ◽  
Vol 21 (6) ◽  
pp. 34-35
Author(s):  
Sarah Warren ◽  
Tim Nanof
Keyword(s):  
Acute Care ◽  
Quality Measures ◽  
Care Quality ◽  
Post Acute Care

Moving in, taking charge in the post-acute care realm

2013 ◽  
Vol 6 (2) ◽  
pp. 1-25
Author(s):  
MARY ELLEN SCHNEIDER
Keyword(s):  
Acute Care ◽  
Taking Charge ◽  
Post Acute Care

Integrating Palliative Care Assessment Tools to Enhance Understanding of Illness Trajectory in Post-Acute Care and Long-Term Care

2021 ◽  
pp. 104990912110181
Author(s):  
Daphna Grossman ◽  
Yona Grossman ◽  
Ezra Nadler ◽  
Mark Rootenberg ◽  
Jurgis Karuza ◽  
...  
Keyword(s):  
Acute Care ◽  
Chart Review ◽  
Assessment Tools ◽  
Illness Trajectory ◽  
Illness Burden ◽  
Palliative Approach ◽  
Interprofessional Care ◽  
Care Assessment ◽  
Understanding Of Illness ◽  
Post Acute Care

Objectives: To determine whether education and integration of the Gold Standard Framework Proactive Identification Guidance (GSF-PIG) and the Palliative Performance Scale (PPS) into care rounds, in post-acute care settings, can facilitate communication between the interprofessional care team to enhance understanding of illness trajectories, identifying those who would benefit from a palliative approach to care. Methods: Interprofessional care teams received training on the GSF-PIG and PPS which were integrated into weekly care rounds and completed a post-evaluation survey. A chart review was conducted for the 40 patients and residents reviewed with the GSF-PIG and PPS. Data analysis included descriptive statistics and comparisons of characteristics between patients and residents who were grouped as positive or negative on the GFS-PIG surprise question using chi square analyzes and t-tests. Results: The GSF-PIG and PPS were found to enhance communication within care teams and enhance understanding of patient and resident’s illness burden. The chart review revealed that patients and residents whom the team would not be surprised if they died within 1 year were older (p = .002), had a lower PPS score (p = .002) and had more indicators of decline (p < .001) compared to patients and residents the team would be surprised if they died within the year. Conclusion: Training interprofessional care teams on the utilization and integration of the GSF-PIG and PPS during weekly care rounds helped increase the understanding of patient and resident illness burden and illness trajectory to identify those who may benefit from a palliative approach to care.

scholarly journals Impact of Multidisciplinary Stroke Post-Acute Care on Cost and Functional Status: A Prospective Study Based on Propensity Score Matching

2021 ◽  
Vol 11 (2) ◽  
pp. 161
Author(s):  
Chong-Chi Chiu ◽  
Jhi-Joung Wang ◽  
Chao-Ming Hung ◽  
Hsiu-Fen Lin ◽  
Hong-Hsi Hsien ◽  
...  
Keyword(s):  
Propensity Score ◽  
Functional Status ◽  
Propensity Score Matching ◽  
Acute Care ◽  
Medical Cost ◽  
Economic Burden ◽  
Stroke Rehabilitation ◽  
Stroke Patients ◽  
The Impact ◽  
Post Acute Care

Few papers discuss how the economic burden of patients with stroke receiving rehabilitation courses is related to post-acute care (PAC) programs. This is the first study to explore the economic burden of stroke patients receiving PAC rehabilitation and to evaluate the impact of multidisciplinary PAC programs on cost and functional status simultaneously. A total of 910 patients with stroke between March 2014 and October 2018 were separated into a PAC group (at two medical centers) and a non-PAC group (at three regional hospitals and one district hospital) by using propensity score matching (1:1). A cost–illness approach was employed to identify the cost categories for analysis in this study according to various perspectives. Total direct medical cost in the per-diem-based PAC cohort was statistically lower than that in the fee-for-service-based non-PAC cohort (p < 0.001) and annual per-patient economic burden of stroke patients receiving PAC rehabilitation is approximately US $354.3 million (in 2019, NT $30.5 = US $1). Additionally, the PAC cohort had statistical improvement in functional status vis-à-vis the non-PAC cohort and total score of each functional status before rehabilitation and was also statistically significant with its total score after one-year rehabilitation training (p < 0.001). Early stroke rehabilitation is important for restoring health, confidence, and safe-care abilities in these patients. Compared to the current stroke rehabilitation system, PAC rehabilitation shortened the waiting time for transfer to the rehabilitation ward and it was indicated as an efficient policy for treatment of stroke in saving medical cost and improving functional status.

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