Examining Post Acute Care Relationships in an Integrated Hospital System

Final Report

February 2009

Prepared for:
Susan Bogasky
Assistant Secretary for Planning and Evaluation (ASPE)
U.S. Department of Health and Human Services

Prepared by:
Barbara Gage, PhD
Melissa Morley, PhD
Pamela Spain, PhD
Melvin Ingber, PhD
RTI International

This report was produced under the direction of Susan Bogasky, Project Officer, Office of the Assistant Secretary for Planning and Evaluation (ASPE), Office of Health Policy. The findings and conclusions of this report are those of the authors and do not necessarily represent the views of ASPE or HHS.

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

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Abstract

This project continues the analysis of Medicare beneficiary level episodes of post-acute care.  RTI builds on its previously funded ASPE project by expanding the episode file to include 2006 claims.  The episode definition initiates with an acute hospital stay and includes all Medicare post acute care services (e.g., long-term care hospitals, skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, outpatient therapy), Part B services, hospice and durable medical equipment. The analysis provides trends on transfer patterns, average payments, average readmission rates, severity of illness factors and other descriptive characteristics of Medicare post acute care users.

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Contents

EXECUTIVE SUMMARY
Section 1 Background
Section 2 Data and Methods
Section 3 Results
Section 4 Discussion

1. Background

2. Data and Methods
2.1 Data Sources
2.2 Episode Construction
2.3 Defining Organizational Relationships
2.4 Descriptive and Multivariate Analyses
2.4.1 Supply of Services
2.4.2 Post-Acute Care Episode Analyses
2.4.3 Multivariate Analyses

3. Results
3.1 Geographic Distribution of Providers
3.1.1 Freestanding versus Hospital within Hospital Long-Term Care Hospitals
3.1.2 Freestanding versus Hospital-based Inpatient Rehabilitation Facilities and Skilled Nursing Facilities
3.1.3 Organizational Relationships in Post-Acute Episodes
3.2 Post-Acute Care Episodes: First Post-Acute Site of Care, Index Admission Length of Stay and Payment
3.3 Diagnosis Related Groups by Hospital and Post-Acute Care Setting
3.4 Description of the Post-Acute Care Sample
3.5 Comorbidities
3.5.1 Prevalence and Rank Order of Hierarchical Condition Categories
3.5.2 Episode Length of Stay and Payment by Number of Hierarchical Condition Categories
3.6 Post-Acute Care Episode Analysis
3.6.1 Episode Utilization and Payment, by All Patient Refined Diagnosis Related Group and Medicare Severity Diagnosis Related Group
3.7 Patterns of Use Within an Episode
3.8 Composition of Total Episode Payments
3.8.1 Part B Physician Service Utilization Within Post-Acute Care Episodes
3.9 Multivariate analysis results
3.9.1 Ordinary Least Squares Regression Predicting Index Admission Length of Stay
3.9.2 Binomial Logit Regression Predicting Use of Post-Acute Care
3.9.3 Multinomial Logit Predicting First Site of Post-Acute Care
3.9.4 Binomial Logit Regression Predicting Readmission During Post-Acute Care Episodes
3.9.5 Ordinary Least Squares Regression Predicting Post-Acute Care Episode Payment

4. Discussion
4.1 Implications of the Findings
4.2 Next Steps

5. References

APPENDIX A

APPENDIX B

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Last updated:  06/19/2009