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  • A Comparison of Risk-Adjustment Models to Explain Outcomes Differences Across Patients Discharged to a Post-Acute Care Provider

    The purpose of this study was to compare different risk adjustment models in terms of their predictive ability to explain outcome differences across patients receiving post-acute care (PAC) services.  Specifically, we compare (1) APR-DRG severity of illness (SOI) levels; (2) KNG Health Consulting’s risk adjustment model; and (3) risk adjustment models used in CMS’ quality measures.  In addition, we present outcome measures that are standardized using APR-DRGs among patients receiving care in different PAC settings.  We use the 2014 Q4 – 2016 Q4 Medicare Inpatient, Skilled Nursing Facility, and Home Health Agency Standard Analytic Files and 2013-2016 Denominator Files to conduct the analysis.

    We examine the effectiveness of different risk adjustment models in explaining the following four outcomes: 90-day mortality, 90-day readmission rates, 90-day Medicare episode payments, and admission to a long-term acute care hospital.

    Services : Health Economics & Outcomes Research Expertise: ,

    The purpose of this study was to compare different risk adjustment models in terms of their predictive ability to explain outcome differences across patients receiving post-acute care (PAC) services.  Specifically, we compare (1) APR-DRG severity of illness (SOI) levels; (2) KNG Health Consulting’s risk adjustment model; and (3) risk adjustment models used in CMS’ quality

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  • Barriers to Hip and Knee Replacement: An Empirical Analysis

    In this study, we examined variations in the determinants of joint replacement (JR) across gender and age, with emphasis on the role of social support and family dynamics.  We analyzed data from the U.S. Health and Retirement Study (1998-2010) on individuals aged 45 or older with no prior receipt of JR. We used logistic regression to analyze the probability of receiving knee or hip replacement by gender and age (<65, 65+).  We estimated the effect of demographic, health needs, economic, and familial support variables on the rate of JR.

    Our results demonstrate that being married/partnered with a healthy spouse/partner is positively associated with JR utilization among men in both age groups (65+ group OR: 1.322 and <65 group OR: 1.476) while it has no statistically significant effect on JR use among women.  Among women younger than 65, having children younger than 18 years old lowers the odds (OR: 0.201) and caring for grandchildren increases the odds (1.364) of having a JR.  Finally,  elderly women who report availability of household assistance from a child have higher odds of receiving a JR as compared with elderly women without a child who could assist (OR: 1.281).  No effect of available support from children was observed for those under 65 years old and elderly men.

    Our results show that intra-family dynamics and familial support are important determinants of JR; however, their effects vary by gender and age.  Establishing appropriate support mechanisms could increase access to cost-effective JR among patients in need of surgery.

    Links: Pending

    Services : Advanced Data Analytics, Health Economics & Outcomes Research Expertise: ,

    In this study, we examined variations in the determinants of joint replacement (JR) across gender and age, with emphasis on the role of social support and family dynamics.  We analyzed data from the U.S. Health and Retirement Study (1998-2010) on individuals aged 45 or older with no prior receipt of JR. We used logistic regression

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  • The Effects of Revision Total Hip Replacement on Medicare Spending and Beneficiary Outcomes: Implications for the Comprehensive Care for Joint Replacement Model

    The Comprehensive Care for Joint Replacement (CJR) model aims to incentivize hospitals to lower costs while increasing quality of care using bundled payments for hip and knee replacement. KNG Health used a Markov model to assess the cost-effectiveness of total hip replacement under Medicare Fee-For-Service (baseline scenario) and CJR scenarios. We used Medicare claims to generate baseline and CJR scenarios to estimate the impact of CJR on 90-day spending. Sensitivity analyses were conducted on revision rates. Our findings suggest Medicare Fee-For-Service would be more cost effective for 65-year-old male patients if revision risk reached a certain threshold. For males at age 75 and females, revision rates need to increase under the CJR scenarios for the CJR model to be more cost-effective than the baseline scenario.

    Links: Pending

    Services : Health Economics & Outcomes Research, Payment Policy & Delivery System Innovation Expertise: , , ,

    The Comprehensive Care for Joint Replacement (CJR) model aims to incentivize hospitals to lower costs while increasing quality of care using bundled payments for hip and knee replacement. KNG Health used a Markov model to assess the cost-effectiveness of total hip replacement under Medicare Fee-For-Service (baseline scenario) and CJR scenarios. We used Medicare claims to

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  • The Effects of Arthroscopy for Symptomatic Femoroacetabular Impingement on Quality of Life and Economic Outcomes

    In collaboration with Dr. Richard Mather III, we examined the societal and economic impact of hip arthroscopy in patients with femoroacetabular impingement (FAI) syndrome under 50 years old. This study used a Markov decision model to assess the cost-effectiveness of hip arthroscopy compared to non-operative treatment. To populate the Markov decision model, we used literature review to determine utilities and other model assumptions. Direct cost estimates were calculated using a private insurance claims dataset within the PearlDriver Patient Records Database and indirect cost estimates were derived from the National Health Interview Survey and patient-reported outcomes collected from two FAI surgeons. Using the information collected, we calculated the incremental cost effectiveness ratio for the two treatment strategies. One, two and three-way sensitivity analyses were performed for all variables and a Monte Carlo simulation was used to assess uncertainty in the model assumptions. Our analysis found that hip arthroscopy provides economic benefits and reduces economic burden on society through indirect cost savings.

    Services : Health Economics & Outcomes Research Expertise: ,

    In collaboration with Dr. Richard Mather III, we examined the societal and economic impact of hip arthroscopy in patients with femoroacetabular impingement (FAI) syndrome under 50 years old. This study used a Markov decision model to assess the cost-effectiveness of hip arthroscopy compared to non-operative treatment. To populate the Markov decision model, we used literature

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  • Assessing the Utilization of Total Ankle Replacement in the United States

    Utilization of total ankle replacement (TAR) has increased in the United States over the last 20 years. In collaboration with Dr. Sudheer Reddy, we investigated the variation in TAR utilization across hospitals and hospital characteristics associated with that variation. We primarily focused on inpatient costs as it related to primary TAR. Data from the Nationwide Inpatient Sample was used to examine description statistics on all TAR patients. We used Medicare Inpatient Limited Data Sets and cost reports to calculate overall hospital all-payer margins and cost-to-charge ratios associated with overall services and “implantable devices” to compute the cost of surgery and the prosthesis, respectively. We found a significant financial burden on utilizing TAR as many health systems have been unable to generate profits despite an increased number of surgeries.

    Links: Publication

    Services : Advanced Data Analytics Expertise:

    Utilization of total ankle replacement (TAR) has increased in the United States over the last 20 years. In collaboration with Dr. Sudheer Reddy, we investigated the variation in TAR utilization across hospitals and hospital characteristics associated with that variation. We primarily focused on inpatient costs as it related to primary TAR. Data from the Nationwide

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  • Skilled Nursing Facility Demand Projections and Market Analyses

    Skilled Nursing Facilities (SNFs) provide short-term skilled nursing care and rehabilitation services. As a critical sector of post-acute care (PAC), SNF spending accounted for 8% of all Medicare fee for service (FFS) spending in 2015, and over 20% of hospitalized FFS beneficiaries were discharged to SNFs. In this study, we estimated SNF occupancy using SNF cost report, and we examined SNF beds and availability of other PAC providers using Provider of Service (POS) file and cost report. We characterized Medicare FFS beneficiaries in SNFs using inpatient standard analytic files. We projected 2018-2022 Medicare SNF days at the county and MSA level using proprietary county-level population projections, projection of growth in Medicare Advantage (MA) penetration, and estimates of SNF utilization for Medicare FFS and MA. Nationally, the number of SNF days is projected to increase by 10.5% between 2018 and 2022, despite the per capita rate falling by 1.5%, accounting for the impact of projected trends in socio-demographic factors in the Medicare population and projected changes in MA penetration.

    Services : Advanced Data Analytics Expertise: ,

    Skilled Nursing Facilities (SNFs) provide short-term skilled nursing care and rehabilitation services. As a critical sector of post-acute care (PAC), SNF spending accounted for 8% of all Medicare fee for service (FFS) spending in 2015, and over 20% of hospitalized FFS beneficiaries were discharged to SNFs. In this study, we estimated SNF occupancy using SNF

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