HOSPITAL USE AND MORTALITY AMONG MEDICARE BENEFICIARIES IN BOSTON AND NEW HAVEN

Size: px
Start display at page:

Download "HOSPITAL USE AND MORTALITY AMONG MEDICARE BENEFICIARIES IN BOSTON AND NEW HAVEN"

Transcription

1 SPECIAL ARTICLE HOSPITAL USE AND MORTALITY AMONG MEDICARE BENEFICIARIES IN BOSTON AND NEW HAVEN JOHN E. WENNBERG, M.D., JEAN L. FREEMAN, PH.D., ROXANNE M. SHELTON, M.A., AND THOMAS A. BUBOLZ, PH.D. From the Department of Community and Family Medicine, Dartmouth Medical School. Hanover, NH 03756, where reprint requests should be addressed to Dr. Wennberg. Supported by a grant (HS05624) from the National Center for Health Services Research. Abstract: We compared rates of hospital use and mortality in fiscal year 1985 among Medicare enrollees in Boston and New Haven, Connecticut. Adjusted rates of discharge, readmission, length of stay, and reimbursement were 47, 29, 15, and 79 percent higher, respectively, in Boston; 40 percent of Boston's deaths occurred in hospitals as compared with 32 percent of New Haven's. High-variation medical conditions (those for which there is little consensus about the need for hospitalization) accounted for most of these differences. By contrast, discharge rates for low-variation medical conditions (which tend to reflect the incidence of disease) were similar. Inpatient case-fatality rates were lower in Boston than in New Haven (RR = 0.85; 95 percent confidence interval, 0.78 to 0.92), but when all deaths (regardless of place of death) were measured, the mortality rates in Boston and New Haven were nearly identical (RR = 0.99; 95 percent confidence interval, 0.93 to 1.05). We conclude that the lower rate of hospital use by Medicare enrollees in New Haven was not associated with a higher overall mortality rate. Population-based as well as hospital-based statistics are needed to evaluate differences in hospital mortality rates for high-variation medical conditions. (N Eng J Med 1989; 321: ) PREVIOUS studies showed that residents of the Boston hospital-service area used about 4.5 beds per thousand population, as compared with less than 3 per thousand for residents of the New Haven, Connecticut, hospital-service area (1, 2) and raised questions about the possible withholding of care in New Haven (2, 3). In 1982 the total number of days in the hospital and expenditures per capita were 44 and 100 percent higher, respectively, in Boston than in New Haven. The higher rate of hospital use among Boston residents was largely due to higher discharge rates involving high-variation medical conditions, such as pneumonia, gastroenteritis, and chronic obstructive lung disease, for which there is little consensus about the need for hospitalization (2). The hospital-discharge rates involving those conditions are known to be highly variable across small geographic areas and are highly correlated with the number of available beds per capita. By contrast, discharge rates involving myocardial infarction, stroke, and gastrointestinal hemorrhage low-variation medical conditions were virtually the same in the two communities. For these low-variation conditions, which are characterized by professional consensus on the need for hospitalization, the hospitalization rates are more closely related to the incidence rates of the diseases (3, 4). What are the implications of these different patterns of use and deployment of resources? Were hospital services underused in New Haven such that the lower rates of hospitalization for high-variation medical conditions were associated with worse outcomes? Although the full exploration of these important issues requires detailed prospective studies, one question can be addressed retrospectively with data on Medicare claims. As adjusted for age, sex, and race, was the overall lower rate of hospital use associated with higher mortality rates? We show in this study that the answer to this question depends on whether mortality is viewed from a hospital-based or population-based perspective. Clinical policies regarding which patients are admitted or readmitted to the hospital, how long they stay, and whether those with terminal illnesses are commonly treated there or elsewhere differed between New Haven and Boston. These clinical policies materially affected hospital-based mortality statistics because they affected the average severity of illnesses among hospitalized patients, the average period during which those with a given condition were under observation,

2 and the likelihood that deaths would appear in hospital-based statistics. Most statistics based on hospitalassociated deaths suggest that mortality rates in Boston were lower than those in New Haven. However, if all deaths (regardless of the place of death) are counted and the rates calculated on the basis of the population, the mortality rates in Boston and New Haven were virtually the same. METHODS Study Population Our study s population consisted of all Medicare beneficiaries 65 years of age or older who were residents of the Boston and New Haven areas between October 1, 1984, and September 30, 1985 (fiscal year 1985). The Boston hospital area includes Boston, Chelsea, Revere, and Brookline, Massachusetts. The New Haven area includes New Haven, West Haven, and East Haven, Connecticut, Data Our study was based on the hospital-claims file (Medicare Part A) and the enrollment file maintained by the Health Care Financing Administration (7). The hospital-claims file contained a record of each hospitalization, clinical and financial information, and selected characteristics of the beneficiary. Elements included diagnoses (up to five); procedures (up to three); the number of the diagnosis-related group (DRG); the patient's age, race, sex, and residential ZIP Code; and the total charges and those reimbursed to Medicare. The enrollment file contained information on all the patients enrolled in the program, including their dates of birth and death, Information was linked across files to determine the number of inpatient deaths and deaths within 30 days of hospital admission and the total number of deaths. Population-Based Rates of Use Rates of use were based on hospital-discharge information from the Medicare Part A tile and population estimates from the enrollment file. We estimated the population of the two study areas at the study's midpoint, April 1, 1985, using year-end enrollment figures from calendar years 1984 and 1985 (three quarters of the December 1984 figure plus one quarter of the December 1985 figure). Unless otherwise specified, all rates in this report were adjusted for demographic characteristics by the indirect method (8). Rates of hospital use (number of discharges per capita, days in the hospital, and reimbursements) for Boston and New Haven included all the discharges of residents, regardless of where their hospitalization occurred. Types of Hospital Discharge Rates of use are also reported for specific types of hospital services in Boston and New Haven. For this purpose we divided all hospitalizations into three categories according to DRG low-variation medical conditions, high-variation medical conditions, and conditions involving surgery (as defined previously (4). Low-variation medical conditions included stroke (DRG number 14), heart attack (121 to 123), and gastrointestinal bleeding (174 and 175). High-variation medical conditions included all other medical DRGs. Hospitalizations involving surgery included all DRGs that are defined on the basis of operating room procedures. The data included 1,431 discharges (of a total of 38,525) in unclassifiable DRGs: 704 in number 468, and 727 in number 470. Those in DPG number 468 were considered surgical. Those in DRG 470 that involved a surgical procedure (286 discharges) were included in the surgical category, and those that did not (441 discharges) were included in the high-variation medical category. Mortality Rates Mortality rates based on all deaths and on hospital-associated deaths are presented for each area. We calculated the population based total mortality rate using all deaths of residents (regardless of the place of death) as the numerator and the estimated size of the Medicare population as the denominator. The number of hospitals associated deaths is reported in two ways. In the first, we counted only inpatient deaths - those in which the beneficiary died while hospitalized, as determined

3 by the date of death from the enrollment file and the date of discharge fro. the hospital-claims file. In the second, we counted deaths that occurred within 30 days of the admission date corresponding to the beneficiary's last hospital discharge in fiscal year 1985, regardless of where death occurred. We calculated the hospital-associated mortality rates using two denominators: the number of relevant discharges in fiscal year 1985 and the estimated Medicare population. The relevant discharges for the inpatient mortality rates were all discharges in the fiscal year that corresponded to the particular type of hospital-associated death (those involving high-variation medical conditions, low-variation medical conditions, or surgery). The relevant discharges for the 30day mortality rates included only the patients' last hospital dis. charges in the fiscal year. This method of computing 30-day mortality rates was used by the Health Care Financing Administration in determining hospital-associated death rates for 1986 (9). We calculated hospital-associated mortality rates on the basis of the estimated Medicare population as a result of Left and Showstack's (10) suggestion that when an adequate means of adjusting for differences in admission criteria is not available, the appropriate denominator for hospital-associated mortality statistics is an area's population rather than the number of hospitalizations. As with the rates of use, all mortality rates were indirectly adjusted (8) for age, race, and sex, and variances were computed with the method of Keyfitz (11). Ninety-five percent confidence limits were calculated for all the Boston: New Haven ratios on the basis of the corresponding variances in each area (12). RESULTS Hospitalization Rates among Medicare Beneficiaries The Medicare populations in Boston and New Haven were similar with respect to sex and race: each was about two-thirds female and almost 15 percent nonwhite. Beneficiaries in Boston were older; 48 percent were at least 75 years of age, as compared with 41 percent in New Haven. The rates of use of hospital services, as adjusted for age, sex, and race, differed substantially in the two communities (Table I)- Beneficiaries in Boston had a discharge rate 47 percent higher than that of beneficiaries in New Haven. Moreover, their hospital stays were 15 percent longer, resulting in a 68 percent larger number of days in the hospital per thousand beneficiaries. Reimbursements were 22 percent higher per case and 79 percent higher per capita. The greater overall use of hospital services per capita in Boston can be attributed to both a higher percentage of hospitalized persons (21.3 vs percent per year) and a higher rate of readmissions (32.9 vs percent per year). Larger differences in rates of use between the two communities were observed in hospitalizations associated with an inpatient death:

4 the average length of stay was 55 percent longer and reimbursements per case were 71 percent higher in Boston than in New Haven; per capita rates of hospital use and expenditures were about twice as high in Boston as in New Haven. In Boston, approximately 65 percent of all discharges involved high-variation medical conditions, 8 percent low-variation medical conditions, and 26 percent surgery. In New Haven, the corresponding figures were 59, 12, and 29 percent. Consistent with previous studies, the overall increase in hospital use in Boston was largely attributable to the provision of services to patients with high-variation medical conditions (Table 2). For these conditions, rates of discharge and number of days in the hospital were-62 and 95 percent higher in Boston. Moreover, reimbursements per capita were twice as high in Boston, and 54 percent of all inpatient reimbursements for Boston hospitalizations involved high-variation medical conditions. If the rates of use for people in Boston had been the same as those for people in New Haven, approximately 136,000 fewer days of hospitalization would have been required. Of these, 92,000 days (72 percent) involved patients with high-variation medical conditions. By contrast, discharge rates for patients with the low-variation conditions were almost identical, although Boston's lengths of stay were 13 percent longer. Likewise, for terminally ill inpatients, differences in rates of hospital use were principally related to the high-variation medical conditions: per capita rates of reimbursement and number of days in the hospital were 157 percent higher in Boston. A previous study(2) found that the higher rate of hospitalization for surgery in Boston was attributable to differences in the rate of hospital use for minor surgical procedures, Overall Population-Based Mortality Rates The overall mortality rates, as adjusted for age, race, and sex, were virtually the same in Boston and New Haven in fiscal year There were no significant differences according to age, sex, or racial group (Table 3).

5 Mortality According to Place of Death and hospital Associated Mortality Clinical preference among the clinicians who treated the Medicare population in Boston favored the inpatient setting for the care of the terminally ill. Approximately 40 percent of the deaths among Medicare beneficiaries in Boston occurred when the decedents were inpatients, as compared with 32 percent of the deaths in New Haven (Table 4). The case-fatality rate (inpatient deaths per 100 discharges) was lower for enrollees in Boston, but the higher discharge rate per 1000 enrollees resulted in the higher population-based inpatient mortality rate (1.47 X 0.85 = 1.25). Most of the inpatient deaths occurred among patients with high-variation medical conditions. Although the case fatality rate among patients with high-variation conditions was lower in Boston, the higher per capita discharge rate involving those conditions combined with the lower case-fatality rate produced a 41 percent higher population-based inpatient mortality rate for beneficiaries in Boston (1.62 X 0.87 = 1.46) By contrast, for patients with low-variation medical conditions, the discharge rate, the number of deaths per 100 discharges, and thus the per capita inpatient death rate were virtually the same in the two populations (0.99 X 1.01 = 1.00). Case-fatality rates based on the 30-day observation period were about 30 percent higher in New Haven than in Boston. However, the mortality statistics based on the number of deaths per capita within 30 days of the admission date corresponding, to the last hospital discharge were nearly the same among the two populations. For enrollees in Boston, the use of a 30-day fixed observation period had little effect on the number of deaths classified as hospital associated; the additional 343 out-of-hospital deaths that fell within the 30-day period were offset by the elimination of 313 deaths among inpatients whose lengths of stay exceeded 30 days. However, this method resulted in a 24 percent increase in the number of hospital associated deaths in New Haven, from 457 to 567. The increase occurred because 150 out-of-hospital deaths were added, whereas only 40 deaths were excluded because of stays of more than 30 days. DISCUSSION We have documented higher rates of discharge and readmission, longer stays, and higher expenditures for hospitalization among the Medicare population in Boston as compared with that in New Haven. Most of the differences in the allocation of hospital resources were accounted for by greater use of the hospital by patients with high-variation medical conditions. Hospitalization for six high-variation conditions alone - pneumonia (DRG numbers 89 and 90), heart failure and shock (127), gastroenteritis (182 and 183), diabetes (294), cardiac arrhythmia (138 and 139), and chronic obstructive lung disease (88) - accounted for 25 percent of the difference in the rate of patient days involving treatment for medical conditions. Clinical practices also differed with regard to the care of the terminally ill: 40 percent of the deaths in Boston occurred in hospitals as compared with 32 percent of those in New Haven; rates of patient days and reimbursement for terminally ill patients who had high-variation medical conditions were about 2.6 times higher in Boston than in New Haven.

6

7 Although total population-based mortality rates were similar in the two areas, hospital-associated mortality rates varied according to the measure employed. When measured as case-fatality rates (deaths per 100 discharges), hospital-associated death rates were higher in New Haven. The increase was due principally to deaths among patients with high-variation medical conditions, both inpatient case fatalities (rates 15 percent higher) and deaths occurring within 30 days of admission (rates 33 percent higher). When measured as deaths per capita, inpatient death rates were 41 percent higher in Boston. However, when measured as deaths occurring within 30 days of admission, the hospital-associated mortality per capita in the two communities was virtually the same. We concluded that these statistics did not imply differences in the skill of clinicians and hospitals in Boston and New Haven in preventing unnecessary deaths, but resulted instead from differences in clinical policies. The limitations of hospital-associated mortality statistics have been discussed extensively, particularly in response to the Health Care Financing Administration's release of hospital-associated death rates and Shortell and Hughes (13) use of such statistics in their study of the effects of regulation on patient outcomes. Although most attention has focused on case severity, the confounding effects of systematic differences in admission and readmission policies, length of stay, and place of treatment of the terminally ill are also at

8 issue. These factors differ simultaneously and variably from region to region, between communities within regions, and from hospital to hospital within communities. Intuitively, one would expect higher rates of admission for medical conditions to be associated with a lower average case severity. However, many factors may confound this association. The availability of home care services, nursing homes, and hospice programs, which affect the likelihood of a patient's dying in the hospital, varies from community to community. Also, a community's use of alternative services is not necessarily a function of the number of hospital beds per capita (14) and thus may not be related in any consistent way to admission thresholds for high-variation medical conditions. Varying lengths of stay and readmission rates add another level of complexity by affecting patients' eligibility for observation. Length of stay affects the inpatient period of observation. When hospital mortality rates are based on a 30-dav period of observation (as used by the Health Care Financing Administration), variations from institution to institution in readmission thresholds result in differential censoring and a downward bias for low variation conditions and surgical procedures in hospitals with low thresholds. For example, patients admitted with myocardial infarction who are readmitted within 30 days with a different diagnosis will not appear under "acute myocardial infarction" in the mortality statistics. Because practice patterns for high-variation medical conditions vary as much as they do, comparing the performance of health systems in treating patients with these conditions presents serious difficulties. The inconsistencies between measures that this study illustrates should be expected. At the community or regional level, population-based statistics that include the total number of deaths as well as hospital-associated deaths can be collected, and the effects of practice patterns can be analyzed with population-based data on use. Errors of interpretation attributable to the confounding effects of practice style can thus be avoided. However, the population at risk for admission to any one hospital is not ordinarily observable. Thus, admission and readmission rates, lengths of stay, and the effects of policies concerning the care of the terminally ill cannot be directly measured for individual hospitals. For this reason, variations in hospital-based mortality rates among patients with high-variation medical conditions (15, 16) should not be interpreted as reflecting differences in clinical skill or productivity. What does our study say about the productivity of hospitals? If the illness rates were similar in Boston and New Haven, there was no discernible difference in survival associated with an 80 percent difference (adjusted for age, sex, and race) in Medicare reimbursements. But what is the evidence that illness rates were similar, given the large difference in rates of hospital use? First, it should be rioted that rates of use for high-variation conditions provide no information on relative illness rates: the discharge rate among patients with high-variation medical conditions is highly correlated with the number of hospital beds per capita but not with illness rates (6). Second, socioeconomic factors were similar in Boston and New Haven (2). Third, the similarity in rates of' discharge involving acute myocardial id1rction, stroke, and gastrointestinal hemorrhage - the low-variation conditions about which physicians agree on the need for hospitalization - is a direct indication that illness rates, at least for common illnesses, such as coronary artery and cerebrovascular disease, were more or less the same. Moreover, the similar mortality rates among patients with these conditions suggest similar end results, at least in one important dimension. Finally, there is no evidence that an increased number of high-variation medical admissions leads to lower mortality. Despite the differences in use and deployment of resources for high-variation medical conditions and the apparent similarity in illness rates, there was no difference in overall population based mortality rates among Medicare beneficiaries in Boston and New Haven. Our study thus supports the opinion of clinicians in New Haven that the lower rate of hospital use in treating high-variation conditions did not constitute a withholding of valuable services (2).But mortality is only one measure of outcome. Did the higher rates of hospitalization in Boston result in less morbidity, fewer complications, and an improved quality of life? Was the dying patient's quality of life better in Boston because hospitals were used more frequently to treat the terminally ill? Beyond the availability of hospital beds, what structural characteristics in the medical care systems of the two cities promoted their differences in practice style? These questions remain. Because the answers may create opportunities to reduce the cost of medical care without damaging the welfare of patients, studying different approaches to the treatment of high-variation medical conditions should have the highest priority oil our research agenda.

9 REFERENCES 1.Wennberg JE. Dealing with medical practice variations: a proposal for action. Health Affairs (Millwood) 1984; 3(2): Wennberg JE, Freeman JL, Culp WJ. Are hospital services rationed in New Haven or over-utilized in Boston? Lancet 1987; 1: Wennberg JE. Small area analysis and the medical cue outcome problem. In: Sechrest L, Bunker J, Perrin E, ads. Improving methods in non-experimental research. Beverly Hills. Calif.: Sage Publications (in press). 4. Wennberg JE, McPherson K, Caper P. Will payment based on diagnosis-related groups control hospital costs? N East I Med 1994; 311: Roos NP, Wennberg JE, McPherson K. Using diagnosis-related groups for studying variations in hospital admissions. Health Cam: Rome Rev 19H8; 9(4) Wennberg JE. Population illness rams do not explain population hospitalization rates: a comment on Mark Blumberg's thesis that morbidity adjustments are needed to interpret small area variations. Med Care 1987; 25: Lave J, Dobson A, Walton C. The potential use of Health Cue Financing data sets for health services research. Health Care Financing Rev 1983; 5:1: Fleiss JI. Statistical methods for rates and proportions. New York- John Wiley, Department of Health and Human Services. Medicare, hospital mortality information Washington, D.C.: Government Printing Office, Lau HS, Showstack JA. Effects of regulation, competition, and ownership on mortality rates among hospital inpatients. N Engl Jour Med 1988; 319: Keyfitz N. Sampling variance of standardized mortality ones. Hum Biol1966; 38: Freeman D. Applied categorical data analysis. New York: Marcel Dekker, 1987: Stencil SM, Hughes FFX. The effects of regulation, competition, and ownership on mortality rates among hospital inpatients. N Eng J Med 1988; 31& Wennberg J, Gittelsohn A. Small area variations in health care delivery. Science 1973; 182: Daley 3, Jencks 5, Draper D, Lenhan C, Thomas N, Walker J. Predicting hospital-associated mortality for Medicare patients: a method for patients with stroke, pneumonia, acute myocardial infarction, and congestive bean failure. JAMA 1988; 260:3617~ Kahn KIL, Brook RH, Draper D, et al. Interpreting hospital mortality data: how can we proceed? JAMA 1989; 260:

Estimation of Standardized Hospital. Costs from Claims Data that Reflect Resource Requirements for Care

Estimation of Standardized Hospital. Costs from Claims Data that Reflect Resource Requirements for Care Estimation of Standardized Hospital 1 Costs from Claims Data that Reflect Resource Requirements for Care JOHN T. SCHOUSBOE, MD, PHD 1,2 MISTI L. PAUDEL MPH 3 BRENT C. TAYLOR, PHD, MPH 3,4 LIH-WEN MAH,

More information

Supplemental Technical Information

Supplemental Technical Information An Introductory Analysis of Potentially Preventable Health Care Events in Minnesota Overview Supplemental Technical Information This document provides additional technical information on the 3M Health

More information

Risk Adjustment Definitions and Methodology

Risk Adjustment Definitions and Methodology Illness Burden Illness burden measures the relative health of the population based upon the number and types of health care services used by that group of people. For instance, if the number is in reference

More information

Preventing Readmissions

Preventing Readmissions Emerging Topics in Healthcare Reform Preventing Readmissions Janssen Pharmaceuticals, Inc. Preventing Readmissions The Patient Protection and Affordable Care Act (ACA) contains several provisions intended

More information

The Role of Insurance in Providing Access to Cardiac Care in Maryland. Samuel L. Brown, Ph.D. University of Baltimore College of Public Affairs

The Role of Insurance in Providing Access to Cardiac Care in Maryland. Samuel L. Brown, Ph.D. University of Baltimore College of Public Affairs The Role of Insurance in Providing Access to Cardiac Care in Maryland Samuel L. Brown, Ph.D. University of Baltimore College of Public Affairs Heart Disease Heart Disease is the leading cause of death

More information

Using Medicare Hospitalization Information and the MedPAR. Beth Virnig, Ph.D. Associate Dean for Research and Professor University of Minnesota

Using Medicare Hospitalization Information and the MedPAR. Beth Virnig, Ph.D. Associate Dean for Research and Professor University of Minnesota Using Medicare Hospitalization Information and the MedPAR Beth Virnig, Ph.D. Associate Dean for Research and Professor University of Minnesota MedPAR Medicare Provider Analysis and Review Includes information

More information

All Patient Refined DRGs (APR-DRGs) An Overview. Presented by Treo Solutions

All Patient Refined DRGs (APR-DRGs) An Overview. Presented by Treo Solutions All Patient Refined DRGs (APR-DRGs) An Overview Presented by Treo Solutions Presentation Highlights History of inpatient classification systems APR-DRGs: what they are, how they work, and why they are

More information

Summary Evaluation of the Medicare Lifestyle Modification Program Demonstration and the Medicare Cardiac Rehabilitation Benefit

Summary Evaluation of the Medicare Lifestyle Modification Program Demonstration and the Medicare Cardiac Rehabilitation Benefit The Centers for Medicare & Medicaid Services' Office of Research, Development, and Information (ORDI) strives to make information available to all. Nevertheless, portions of our files including charts,

More information

The Cost-Effectiveness of Homecare

The Cost-Effectiveness of Homecare The Cost-Effectiveness of Homecare Homecare Reduces Costs by 37 Percent for Heart Failure Patients The May 2004 Journal of the American Geriatrics Society reports a study conducted at six Philadelphia

More information

Reducing Hospital Readmissions & The Affordable Care Act

Reducing Hospital Readmissions & The Affordable Care Act Reducing Hospital Readmissions & The Affordable Care Act The Game Has Changed Drastically Reducing MSPB Measures Chuck Bongiovanni, MSW, MBA, NCRP, CSA, CFE Chuck Bongiovanni, MSW, MBA, NCRP, CSA, CFE

More information

Medicare Savings and Reductions in Rehospitalizations Associated with Home Health Use

Medicare Savings and Reductions in Rehospitalizations Associated with Home Health Use Medicare Savings and Reductions in Rehospitalizations Associated with Home Health Use June 23, 2011 Avalere Health LLC Avalere Health LLC The intersection of business strategy and public policy Table of

More information

Medical Care Costs for Diabetes Associated with Health Disparities Among Adults Enrolled in Medicaid in North Carolina

Medical Care Costs for Diabetes Associated with Health Disparities Among Adults Enrolled in Medicaid in North Carolina No. 160 August 2009 Among Adults Enrolled in Medicaid in North Carolina by Paul A. Buescher, Ph.D. J. Timothy Whitmire, Ph.D. Barbara Pullen-Smith, M.P.H. A Joint Report from the and the Office of Minority

More information

Virtual Mentor American Medical Association Journal of Ethics November 2006, Volume 8, Number 11: 771-775.

Virtual Mentor American Medical Association Journal of Ethics November 2006, Volume 8, Number 11: 771-775. Virtual Mentor American Medical Association Journal of Ethics November 2006, Volume 8, Number 11: 771-775. Medicine and society Crowded conditions: coming to an ER near you by Jessamy Taylor Most people

More information

Measure Information Form (MIF) #275, adapted for quality measurement in Medicare Accountable Care Organizations

Measure Information Form (MIF) #275, adapted for quality measurement in Medicare Accountable Care Organizations ACO #9 Prevention Quality Indicator (PQI): Ambulatory Sensitive Conditions Admissions for Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Data Source Measure Information Form (MIF)

More information

3M Health Information Systems. Potentially Preventable Readmissions Classification System. Methodology Overview GRP 139 05/08

3M Health Information Systems. Potentially Preventable Readmissions Classification System. Methodology Overview GRP 139 05/08 3M Health Information Systems Potentially Preventable Readmissions Classification System Methodology Overview 3 GRP 139 05/08 Document number GRP 139 05/08 Copyright 2008, 3M. All rights reserved. This

More information

2014: Volume 4, Number 1. A publication of the Centers for Medicare & Medicaid Services, Office of Information Products & Data Analytics

2014: Volume 4, Number 1. A publication of the Centers for Medicare & Medicaid Services, Office of Information Products & Data Analytics 2014: Volume 4, Number 1 A publication of the Centers for Medicare & Medicaid Services, Office of Information Products & Data Analytics Medicare Post-Acute Care Episodes and Payment Bundling Melissa Morley,¹

More information

PATTERNS OF POST-ACUTE UTILIZATION IN RURAL AND URBAN COMMUNITIES: HOME HEALTH, SKILLED NURSING, AND INPATIENT MEDICAL REHABILITATION.

PATTERNS OF POST-ACUTE UTILIZATION IN RURAL AND URBAN COMMUNITIES: HOME HEALTH, SKILLED NURSING, AND INPATIENT MEDICAL REHABILITATION. PATTERNS OF POST-ACUTE UTILIZATION IN RURAL AND URBAN COMMUNITIES: HOME HEALTH, SKILLED NURSING, AND INPATIENT MEDICAL REHABILITATION Final Report March 2005 Janet P. Sutton, Ph.D. NORC Walsh Center for

More information

Risk Adjustment in the Medicare ACO Shared Savings Program

Risk Adjustment in the Medicare ACO Shared Savings Program Risk Adjustment in the Medicare ACO Shared Savings Program Presented by: John Kautter Presented at: AcademyHealth Conference Baltimore, MD June 23-25, 2013 RTI International is a trade name of Research

More information

Medicare Hospital Quality Chartbook

Medicare Hospital Quality Chartbook Medicare Hospital Quality Chartbook Performance Report on Outcome Measures SEPTEMBER 2014 AMI COPD Heart Failure Pneumonia Stroke 0.5 0.4 Density 0.3 0.1 30 0.0 25 0 10 20 30 30 day Risk standardized Mortality

More information

Inpatient Transfers, Discharges and Readmissions July 19, 2012

Inpatient Transfers, Discharges and Readmissions July 19, 2012 Inpatient Transfers, Discharges and Readmissions July 19, 2012 Discharge Status Codes Two-digit code Identifies where the patient is at conclusion of encounter Visit Inpatient stay End of billing cycle

More information

FINANCIAL IMPLICATIONS OF EXCESS HOSPITAL READMISSIONS JOSESPH B. HENDERSON, J.D.

FINANCIAL IMPLICATIONS OF EXCESS HOSPITAL READMISSIONS JOSESPH B. HENDERSON, J.D. FINANCIAL IMPLICATIONS OF EXCESS HOSPITAL READMISSIONS JOSESPH B. HENDERSON, J.D. Executive MHA Candidate, 2013 University of Southern California Sol Price School of Public Policy Abstract A 2007 Medicare

More information

Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION

Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION At the end of this session, you will be able to: Identify ways RT skills can be utilized for

More information

Medicare Beneficiaries Out-of-Pocket Spending for Health Care

Medicare Beneficiaries Out-of-Pocket Spending for Health Care Insight on the Issues OCTOBER 2015 Beneficiaries Out-of-Pocket Spending for Health Care Claire Noel-Miller, MPA, PhD AARP Public Policy Institute Half of all beneficiaries in the fee-for-service program

More information

POLICY BRIEF. Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time? October 2015. rhrc.umn.edu

POLICY BRIEF. Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time? October 2015. rhrc.umn.edu POLICY BRIEF October 2015 Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time? Peiyin Hung, MSPH Michelle Casey, MS Ira Moscovice, PhD Key Findings Over the first three years

More information

A Comparison of Costs Between Medical and Surgical Patients in an Academic Pediatric Intensive Care Unit

A Comparison of Costs Between Medical and Surgical Patients in an Academic Pediatric Intensive Care Unit ORIGINAL RESEARCH A Comparison of Costs Between Medical and Surgical Patients in an Academic Pediatric Intensive Care Unit Benson S. Hsu, MD, MBA; Thomas B. Brazelton III, MD, MPH ABSTRACT Objective: To

More information

Abstract. Introduction. Number 84 n September 28, 2015

Abstract. Introduction. Number 84 n September 28, 2015 Number 84 n September 28, 2015 Hospitalization, Readmission, and Death Experience of Noninstitutionalized Medicare Fee-for-service Beneficiaries Aged 65 and Over by Yelena Gorina M.S., M.P.H.; Laura A.

More information

Overview and Legal Context

Overview and Legal Context Impact of ACOs on Physician/Provider Membership Decisions 0 Overview and Legal Context Michael R. Callahan Katten Muchin Rosenman LLP Vice Chair, Medical Staff Credentialing and Peer Review Practice Group

More information

Value-Based Purchasing Program Overview. Maida Soghikian, MD Grand Rounds Scripps Green Hospital November 28, 2012

Value-Based Purchasing Program Overview. Maida Soghikian, MD Grand Rounds Scripps Green Hospital November 28, 2012 Value-Based Purchasing Program Overview Maida Soghikian, MD Grand Rounds Scripps Green Hospital November 28, 2012 Presentation Overview Background and Introduction Inpatient Quality Reporting Program Value-Based

More information

Greg Peterson, MPA, PhD candidate Melissa McCarthy, PhD Presentation for 2013 AcademyHealth Annual Research Meeting

Greg Peterson, MPA, PhD candidate Melissa McCarthy, PhD Presentation for 2013 AcademyHealth Annual Research Meeting Greg Peterson, MPA, PhD candidate Melissa McCarthy, PhD Presentation for 2013 AcademyHealth Annual Research Meeting Medicare Coordinated Care Demonstration (MCCD) Established in Balanced Budget Act of

More information

Data Shows Reduction in Medicare Hospital Readmission Rates During 2012

Data Shows Reduction in Medicare Hospital Readmission Rates During 2012 Medicare & Medicaid Research Review 2013: Volume 3, Number 2 A publication of the Centers for Medicare & Medicaid Services, Office of Information Products & Data Analytics Data Shows Reduction in Medicare

More information

benchmarking tools for reducing costs of care

benchmarking tools for reducing costs of care APRIL 2009 healthcare financial management COVER STORY William Shoemaker benchmarking tools for reducing costs of care In the face of the nation s economic challenges, hospitals are under increasing pressure

More information

Chapter Seven Value-based Purchasing

Chapter Seven Value-based Purchasing Chapter Seven Value-based Purchasing Value-based purchasing (VBP) is a pay-for-performance program that affects a significant and growing percentage of Medicare reimbursement for medical providers. It

More information

HOW TO UNDERSTAND YOUR QUALITY AND RESOURCE USE REPORT

HOW TO UNDERSTAND YOUR QUALITY AND RESOURCE USE REPORT HOW TO UNDERSTAND YOUR QUALITY AND RESOURCE USE REPORT CONTENTS A BACKGROUND AND PURPOSE OF THE MID-YEAR QUALITY AND RESOURCE USE REPORTS... 1 B EXHIBITS INCLUDED IN THE MID-YEAR QUALITY AND RESOURCE USE

More information

PRESCRIPTION DRUG COSTS FOR MEDICARE BENEFICIARIES: COVERAGE AND HEALTH STATUS MATTER

PRESCRIPTION DRUG COSTS FOR MEDICARE BENEFICIARIES: COVERAGE AND HEALTH STATUS MATTER PRESCRIPTION DRUG COSTS FOR MEDICARE BENEFICIARIES: COVERAGE AND HEALTH STATUS MATTER Bruce Stuart, Dennis Shea, and Becky Briesacher January 2000 ISSUE BRIEF How many Medicare beneficiaries lack prescription

More information

Principles on Health Care Reform

Principles on Health Care Reform American Heart Association Principles on Health Care Reform The American Heart Association has a longstanding commitment to approaching health care reform from the patient s perspective. This focus including

More information

Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge

Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge PREPARED FOR: ARA Research Institute PRESENTED BY: Al Dobson, Ph.D. PREPARED

More information

How Will Hospital Readmission Penalties Impact Skilled Nursing Facilities?

How Will Hospital Readmission Penalties Impact Skilled Nursing Facilities? How Will Hospital Readmission Penalties Impact Skilled Nursing Facilities? Patrick V. Trotta, CPA Director of ElderCare Provider Services Glass Jacobson patrick.trotta@glassjacobson.com 410 356 1000 Presentation

More information

Lowering Costs and Improving Outcomes. Patient Engagement Issues. Nancy Davenport-Ennis President & CEO. September 8 th, 2009

Lowering Costs and Improving Outcomes. Patient Engagement Issues. Nancy Davenport-Ennis President & CEO. September 8 th, 2009 The Healthcare Imperative: Lowering Costs and Improving Outcomes Patient Engagement Issues Nancy Davenport-Ennis President & CEO National Patient Advocate Foundation September 8 th, 2009 Institute of Medicine

More information

By January 2000, approximately one sixth of all Medicare beneficiaries were

By January 2000, approximately one sixth of all Medicare beneficiaries were Does Risk Adjustment for Medicare Patients Reward Caring for Sick Patients or Liberal Admission Practices? POLICY MATTERS W. PETE WELCH, PhD American Association of Health Plans Washington, DC Eff Clin

More information

Home Health Care Today: Higher Acuity Level of Patients Highly skilled Professionals Costeffective Uses of Technology Innovative Care Techniques

Home Health Care Today: Higher Acuity Level of Patients Highly skilled Professionals Costeffective Uses of Technology Innovative Care Techniques Comprehensive EHR Infrastructure Across the Health Care System The goal of the Administration and the Department of Health and Human Services to achieve an infrastructure for interoperable electronic health

More information

Facts about Diabetes in Massachusetts

Facts about Diabetes in Massachusetts Facts about Diabetes in Massachusetts Diabetes is a disease in which the body does not produce or properly use insulin (a hormone used to convert sugar, starches, and other food into the energy needed

More information

Medicare- Medicaid Enrollee State Profile

Medicare- Medicaid Enrollee State Profile Medicare- Medicaid Enrollee State Profile Montana Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6

More information

Service delivery interventions

Service delivery interventions Service delivery interventions S A S H A S H E P P E R D D E P A R T M E N T O F P U B L I C H E A L T H, U N I V E R S I T Y O F O X F O R D CO- C O O R D I N A T I N G E D I T O R C O C H R A N E E P

More information

Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program

Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program Cristina Boccuti and Giselle Casillas For Medicare patients, hospitalizations can be stressful; even more so when

More information

Integrating Data to Support Care Management Transformation

Integrating Data to Support Care Management Transformation Integrating Data to Support Care Management Transformation The Washington State Experience David Mancuso, PhD Director, Research and Data Analysis Division Washington State Department of Social and Health

More information

Physician and other health professional services

Physician and other health professional services O n l i n e A p p e n d i x e s 4 Physician and other health professional services 4-A O n l i n e A p p e n d i x Access to physician and other health professional services 4 a1 Access to physician care

More information

INSIGHT on the Issues

INSIGHT on the Issues INSIGHT on the Issues AARP Public Policy Institute Medicare Beneficiaries Out-of-Pocket for Health Care Claire Noel-Miller, PhD AARP Public Policy Institute Medicare beneficiaries spent a median of $3,138

More information

FULL COVERAGE FOR PREVENTIVE MEDICATIONS AFTER MYOCARDIAL INFARCTION IMPACT ON RACIAL AND ETHNIC DISPARITIES

FULL COVERAGE FOR PREVENTIVE MEDICATIONS AFTER MYOCARDIAL INFARCTION IMPACT ON RACIAL AND ETHNIC DISPARITIES FULL COVERAGE FOR PREVENTIVE MEDICATIONS AFTER MYOCARDIAL INFARCTION IMPACT ON RACIAL AND ETHNIC DISPARITIES Niteesh K. Choudhry, MD, PhD Harvard Medical School Division of Pharmacoepidemiology and Pharmacoeconomics

More information

Innovations@Home. Home Health Initiatives Reduce Avoidable Readmissions by Leveraging Innovation

Innovations@Home. Home Health Initiatives Reduce Avoidable Readmissions by Leveraging Innovation How Does CMS Measure the Rate of Acute Care Hospitalization (ACH)? Until January 2013, CMS measured Acute Care Hospitalization (ACH) through the Outcomes Assessment and Information Set (OASIS) reporting

More information

Little Ado (yet) About Much (money)

Little Ado (yet) About Much (money) The Concentration of Health Care Spending: Little Ado (yet) About Much (money) Walter P Wodchis Peter Austin, Alice Newman, Ashley Corallo, David Henry Institute for Clinical Evaluative Sciences CAHSPR

More information

Truven Health Analytics: Market Expert Inpatient Volume Projection Methodology

Truven Health Analytics: Market Expert Inpatient Volume Projection Methodology Truven Health Analytics: Market Expert Inpatient Volume Projection Methodology Truven s inpatient volume forecaster produces five and ten year volume projections by DRG and zip code. Truven uses two primary

More information

DC Medicaid. Specialty Hospital Project Per Stay Training. August 20, 2014. Government Healthcare Solutions Payment Method Development

DC Medicaid. Specialty Hospital Project Per Stay Training. August 20, 2014. Government Healthcare Solutions Payment Method Development DC Medicaid Specialty Hospital Project Per Stay Training August 20, 2014 Government Healthcare Solutions Payment Method Development Agenda Introductions Background APR-DRG overview Payment details System

More information

Improving risk adjustment in the Medicare program

Improving risk adjustment in the Medicare program C h a p t e r2 Improving risk adjustment in the Medicare program C H A P T E R 2 Improving risk adjustment in the Medicare program Chapter summary In this chapter Health plans that participate in the

More information

Quick Turnaround with Administrative Health Data

Quick Turnaround with Administrative Health Data Quick Turnaround with Administrative Health Data Katherine Giuriceo, PhD Research and Rapid Cycle Evaluation Group Center for Medicare and Medicaid Innovation, CMS October 2, 2015 1 Overview Center for

More information

Medicare- Medicaid Enrollee State Profile

Medicare- Medicaid Enrollee State Profile Medicare- Medicaid Enrollee State Profile North Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6 Spending...

More information

Long-Term Acute Care Hospitals

Long-Term Acute Care Hospitals Long-Term Acute Care Hospitals What are they? What services do they offer? Presented by: Maxi Adams MBA, BSN, RN LTACH STACH LTACH = Long-Term Acute Care Hospital STACH = Short-Term Acute Care Hospital

More information

Coronary Heart Disease (CHD) Brief

Coronary Heart Disease (CHD) Brief Coronary Heart Disease (CHD) Brief What is Coronary Heart Disease? Coronary Heart Disease (CHD), also called coronary artery disease 1, is the most common heart condition in the United States. It occurs

More information

The Economic Benefit of Public Funding of Insulin Pumps in. New Brunswick

The Economic Benefit of Public Funding of Insulin Pumps in. New Brunswick The Economic Benefit of Public Funding of Insulin Pumps in New Brunswick Introduction Diabetes is a chronic, often debilitating and sometimes fatal disease, in which the body either cannot produce insulin

More information

Post-Acute Care and Long-Term Care: A Complex Relationship

Post-Acute Care and Long-Term Care: A Complex Relationship Post-Acute Care and Long-Term Care: A Complex Relationship PRESENTED TO: 2011 Long-Term Care Interest Group Policy Seminar PRESENTED BY: Allen Dobson, Ph.D. PREPARED BY: Allen Dobson, Ph.D., Joan E. DaVanzo,

More information

Care and EHR Integration Connecting Physical and Behavioral Health in the EHR. Tarzana Treatment Centers Integrated Healthcare

Care and EHR Integration Connecting Physical and Behavioral Health in the EHR. Tarzana Treatment Centers Integrated Healthcare Care and EHR Integration Connecting Physical and Behavioral Health in the EHR Tarzana Treatment Centers Integrated Healthcare Outline of Presentation Why Integrate Care? Integrated Care at Tarzana Treatment

More information

The TeleHealth Model

The TeleHealth Model The Model CareCycle Solutions The Solution Calendar Year 2011 Company Overview CareCycle Solutions (CCS) specializes in managing the needs of chronically ill patients through the use of Interventional

More information

ANNALS OF HEALTH LAW Advance Directive VOLUME 20 SPRING 2011 PAGES 134-143. Value-Based Purchasing As a Bridge Between Value and Access

ANNALS OF HEALTH LAW Advance Directive VOLUME 20 SPRING 2011 PAGES 134-143. Value-Based Purchasing As a Bridge Between Value and Access ANNALS OF HEALTH LAW Advance Directive VOLUME 20 SPRING 2011 PAGES 134-143 Value-Based Purchasing As a Bridge Between Value and Access Erin Lau* I. INTRODUCTION By definition, the words value and access

More information

Type 1 Diabetes ( Juvenile Diabetes)

Type 1 Diabetes ( Juvenile Diabetes) Type 1 Diabetes W ( Juvenile Diabetes) hat is Type 1 Diabetes? Type 1 diabetes, also known as juvenile-onset diabetes, is one of the three main forms of diabetes affecting millions of people worldwide.

More information

CMS National Dry Run: All-Cause Unplanned Readmission Measure for 30 Days Post Discharge from Inpatient Rehabilitation Facilities

CMS National Dry Run: All-Cause Unplanned Readmission Measure for 30 Days Post Discharge from Inpatient Rehabilitation Facilities CMS National Dry Run: All-Cause Unplanned Readmission Measure for 30 Days Post Discharge from Inpatient Rehabilitation Facilities Special Open Door Forum October 20, 2015 2-3 PM ET RTI International is

More information

Compliance. TODAY November 2012. Meet Urton Anderson

Compliance. TODAY November 2012. Meet Urton Anderson Compliance TODAY November 2012 a publication of the health care compliance association www.hcca-info.org Meet Urton Anderson Clark W. Thompson Jr. Professor in Accounting Education McCombs School of Business

More information

SECTION 4 COSTS FOR INPATIENT HOSPITAL STAYS HIGHLIGHTS

SECTION 4 COSTS FOR INPATIENT HOSPITAL STAYS HIGHLIGHTS SECTION 4 COSTS FOR INPATIENT HOSPITAL STAYS EXHIBIT 4.1 Cost by Principal Diagnosis... 44 EXHIBIT 4.2 Cost Factors Accounting for Growth by Principal Diagnosis... 47 EXHIBIT 4.3 Cost by Age... 49 EXHIBIT

More information

Appendix C. Examples of Per-Case and DRG Payment Systems

Appendix C. Examples of Per-Case and DRG Payment Systems Appendix C. Examples of Per-Case and DRG Payment Systems Diagnosis Related Groups (DRGs) have been used in three State ratesetting systems, as well as in the Medicare reimbursement system under the Tax

More information

Hospitalization Trends in North Carolina Medicaid

Hospitalization Trends in North Carolina Medicaid Data Brief August 26, 2015 Issue No. 2 Hospitalization Trends in North Carolina Medicaid Patients with Multiple Chronic Conditions, 2008-2014 Authors: C. Annette DuBard, MD, MPH; Carlos Jackson, PhD KEY

More information

Methodological Issues in Comparing Hospital Performance: Measures, Risk Adjustment, and Public Reporting

Methodological Issues in Comparing Hospital Performance: Measures, Risk Adjustment, and Public Reporting Methodological Issues in Comparing Hospital Performance: Measures, Risk Adjustment, and Public Reporting Harlan M. Krumholz, MD Yale University School of Medicine July 31, 2015 2015 National Forum on Pay

More information

USE OF HOME HEALTH SERVICES AMONG HIGH-RISK RURAL MEDICARE BENEFICIARIES AND OUTCOMES OF CARE

USE OF HOME HEALTH SERVICES AMONG HIGH-RISK RURAL MEDICARE BENEFICIARIES AND OUTCOMES OF CARE USE OF HOME HEALTH SERVICES AMONG HIGH-RISK RURAL MEDICARE BENEFICIARIES AND OUTCOMES OF CARE AOTA/AOTF PRE-CONFERENCE INSTITUTE TRACY MROZ, PHD, OTR/L APRIL 6, 2016 BACKGROUND Home health playing increasing

More information

INTRODUCTION. 7 DISCUSSION AND ONGOING RESEARCH.. 29 ACKNOWLEDGEMENTS... 30 ENDNOTES.. 31

INTRODUCTION. 7 DISCUSSION AND ONGOING RESEARCH.. 29 ACKNOWLEDGEMENTS... 30 ENDNOTES.. 31 May 2010 Working Paper: Using State Hospital Discharge Data to Compare Readmission Rates in Medicare Advantage and Medicare s Traditional Fee-for-Service Program TABLE OF CONTENTS SUMMARY 1 INTRODUCTION.

More information

Medicare- Medicaid Enrollee State Profile

Medicare- Medicaid Enrollee State Profile Medicare- Medicaid Enrollee State Profile Kentucky Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization...

More information

PL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems

PL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems PL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems By Kathleen M. Griffin, PhD. There are three key provisions of the law that will have direct impact on post-acute care needs

More information

Results from the Commonwealth Fund s State Scorecard on Health System Performance Kansas in comparison to Iowa

Results from the Commonwealth Fund s State Scorecard on Health System Performance Kansas in comparison to Iowa Results from the Commonwealth Fund s State Scorecard on Health System Performance Kansas in comparison to Iowa Aiming Higher: Results from a State Scorecard on Health System Performance, published by the

More information

Site-neutral payments for select conditions treated in inpatient rehabilitation facilities and skilled nursing facilities

Site-neutral payments for select conditions treated in inpatient rehabilitation facilities and skilled nursing facilities C h a p t e r6 Site-neutral payments for select conditions treated in inpatient rehabilitation facilities and skilled nursing facilities C H A P T E R 6 Site-neutral payments for select conditions treated

More information

Diabetes-Related Utilization and Costs for Inpatient and Outpatient Services in the Veterans Administration

Diabetes-Related Utilization and Costs for Inpatient and Outpatient Services in the Veterans Administration O R I G I N A L A R T I C L E Diabetes-Related Utilization and Costs for Inpatient and Outpatient Services in the Veterans Administration MATTHEW L. MACIEJEWSKI, PHD 1,2 CHARLES MAYNARD, PHD 1,2 OBJECTIVE

More information

Medicare- Medicaid Enrollee State Profile

Medicare- Medicaid Enrollee State Profile Medicare- Medicaid Enrollee State Profile Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6 Spending...

More information

Refining the hospital readmissions reduction program

Refining the hospital readmissions reduction program Refining the hospital readmissions reduction program C h a p t e r4 C H A P T E R 4 Refining the hospital readmissions reduction program Chapter summary In this chapter In 2008, the Commission reported

More information

Results of Surgery in a New Lung Institute in South Texas Focused on the Treatment of Lung Cancer

Results of Surgery in a New Lung Institute in South Texas Focused on the Treatment of Lung Cancer Results of Surgery in a New Lung Institute in South Texas Focused on the Treatment of Lung Cancer Lung cancer accounts for 13% of all cancer diagnoses and is the leading cause of cancer death in both males

More information

Pricing the Critical Illness Risk: The Continuous Challenge.

Pricing the Critical Illness Risk: The Continuous Challenge. Pricing the Critical Illness Risk: The Continuous Challenge. To be presented at the 6 th Global Conference of Actuaries, New Delhi 18 19 February 2004 Andres Webersinke, ACTUARY (DAV), FASSA, FASI 9 RAFFLES

More information

Moving Towards Bundled Payment

Moving Towards Bundled Payment ISSUE BRIEF Moving Towards Bundled Payment Introduction The fee-for-service system of payment for health care services is widely thought to be one of the major culprits in driving up U.S. health care costs.

More information

National Medicare Readmission. Centers for Medicare and Medicare Services

National Medicare Readmission. Centers for Medicare and Medicare Services National Medicare Readmission Findings: Recent Data and Trends Office of Information Products and Data Analytics Office of Information Products and Data Analytics Centers for Medicare and Medicare Services

More information

Open and Honest Care in your Local Hospital

Open and Honest Care in your Local Hospital Open and Honest Care in your Local Hospital The Open and Honest Care: Driving Improvement Programme aims to support organisations to become more transparent and consistent in publishing safety, experience

More information

Summary and general discussion

Summary and general discussion Chapter 7 Summary and general discussion Summary and general discussion In this thesis, treatment of vitamin K antagonist-associated bleed with prothrombin complex concentrate was addressed. In this we

More information

California Children s Services Program Analysis Final Report

California Children s Services Program Analysis Final Report California Children s Services Program Analysis Final Report Paul H. Wise, MD, MPH Vandana Sundaram, MPH Lisa Chamberlain, MD, MPH Ewen Wang, MD Olga Saynina, MS Jia Chan, MS Kristen Chan, MASc Beate Danielsen,

More information

Brief Research Report: Fountain House and Use of Healthcare Resources

Brief Research Report: Fountain House and Use of Healthcare Resources ! Brief Research Report: Fountain House and Use of Healthcare Resources Zachary Grinspan, MD MS Department of Healthcare Policy and Research Weill Cornell Medical College, New York, NY June 1, 2015 Fountain

More information

Chart 11-1. Number of dialysis facilities is growing, and share of for-profit and freestanding dialysis providers is increasing

Chart 11-1. Number of dialysis facilities is growing, and share of for-profit and freestanding dialysis providers is increasing 11 0 Chart 11-1. Number of dialysis facilities is growing, and share of for-profit and freestanding dialysis providers is increasing Average annual percent change 2014 2009 2014 2013 2014 Total number

More information

Measuring and Benchmarking Hospital Re-Admission Rates for Quality Improvement. Second National Medicare Readmissions Summit Cary Sennett, MD, PhD

Measuring and Benchmarking Hospital Re-Admission Rates for Quality Improvement. Second National Medicare Readmissions Summit Cary Sennett, MD, PhD Measuring and Benchmarking Hospital Re-Admission Rates for Quality Improvement Second National Medicare Readmissions Summit Cary Sennett, MD, PhD Presentation Outline & Goals The Problem of Readmission

More information

White Paper. Medicare Part D Improves the Economic Well-Being of Low Income Seniors

White Paper. Medicare Part D Improves the Economic Well-Being of Low Income Seniors White Paper Medicare Part D Improves the Economic Well-Being of Low Income Seniors Kathleen Foley, PhD Barbara H. Johnson, MA February 2012 Table of Contents Executive Summary....................... 1

More information

NOVOSTE BETA-CATH SYSTEM

NOVOSTE BETA-CATH SYSTEM HOSPITAL INPATIENT AND OUTPATIENT BILLING GUIDE FOR THE NOVOSTE BETA-CATH SYSTEM INTRAVASCULAR BRACHYTHERAPY DEVICE This guide is intended solely for use as a tool to help hospital billing staff resolve

More information

Geographic Variation in Health Care and the Problem of Measuring Racial Disparities

Geographic Variation in Health Care and the Problem of Measuring Racial Disparities Geographic Variation in Health Care and the Problem of Measuring Racial Disparities Katherine Baicker, * Amitabh Chandra, * and Jonathan S. Skinner * ABSTRACT In its study of racial and ethnic disparities

More information

Facilities contract with Medicare to furnish

Facilities contract with Medicare to furnish Facilities contract with Medicare to furnish acute inpatient care and agree to accept predetermined acute Inpatient Prospective Payment System (IPPS) rates as payment in full. The inpatient hospital benefit

More information

Accountable Care Organizations: Forging Stakeholder Partnerships for Health Care Performance and Efficiency

Accountable Care Organizations: Forging Stakeholder Partnerships for Health Care Performance and Efficiency Accountable Care Organizations: Forging Stakeholder Partnerships for Health Care Performance and Efficiency Julie Lewis Director of Health Policy Dartmouth Institute for Health Policy and Clinical Practice

More information

Measures for the Australian health system. Belinda Emms Health Care Safety and Quality Unit Australian Institute of Health and Welfare

Measures for the Australian health system. Belinda Emms Health Care Safety and Quality Unit Australian Institute of Health and Welfare Measures for the Australian health system Belinda Emms Health Care Safety and Quality Unit Australian Institute of Health and Welfare Two sets of indicators The National Safety and Quality Indicators Performance

More information

Chapter 7 Acute Care Inpatient/Outpatient Hospital Services

Chapter 7 Acute Care Inpatient/Outpatient Hospital Services Chapter 7: Acute Care Inpatient/ Outpatient Hospital Services Executive Summary Description Acute care hospitals are the largest group of enrolled hospital providers. Kansas Medicaid has 144 acute care

More information

Handling the Handoff: Rural and Race-Based Disparities in Post-Hospitalization. Follow-up Care Among Medicare Beneficiaries with Diabetes.

Handling the Handoff: Rural and Race-Based Disparities in Post-Hospitalization. Follow-up Care Among Medicare Beneficiaries with Diabetes. Handling the Handoff: Rural and Race-Based Disparities in Post-Hospitalization Follow-up Care Among Medicare Beneficiaries with Diabetes South Carolina Rural Health Research Center At the Heart of Health

More information

Developing Successful Hospital Partnerships

Developing Successful Hospital Partnerships Developing Successful Hospital Partnerships Michael Logan, MHA Director of Operations Services Publication Date: May 2013 2013 Sawgrass Partners, LLC DEVELOPING SUCCESSFUL HOSPITAL PARTNERSHIPS Those aging

More information

The Economic Benefit of Public Funding of Insulin Pumps in Prince Edward Island

The Economic Benefit of Public Funding of Insulin Pumps in Prince Edward Island The Economic Benefit of Public Funding of Insulin Pumps in Prince Edward Island Executive Summary Every day, Prince Edward Islanders living with type 1 diabetes take insulin to live. Many deliver insulin

More information

Use and Integration of Freely Available U.S. Public Use Files to Answer Pharmacoeconomic Questions: Deciphering the Alphabet Soup

Use and Integration of Freely Available U.S. Public Use Files to Answer Pharmacoeconomic Questions: Deciphering the Alphabet Soup Use and Integration of Freely Available U.S. Public Use Files to Answer Pharmacoeconomic Questions: Deciphering the Alphabet Soup Prepared by Ovation Research Group for the National Library of Medicine

More information

DRAFT. Background About Shared Savings Program Design Features: Patient Attribution, Cost Target Calculation, and Payment Calculation and Distribution

DRAFT. Background About Shared Savings Program Design Features: Patient Attribution, Cost Target Calculation, and Payment Calculation and Distribution Background About Shared Savings Program Design Features: Patient Attribution, Cost Target Calculation, and Payment Calculation and Distribution Excerpted from Draft Narratives Developed in the CT SIM Equity

More information