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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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  • Explaining Hospital Charge Variation for Members of America’s Essential Hospitals: The Role of Mark-ups and Underlying Costs

    In a changing healthcare environment in which providers are under increasing demands to demonstrate their value, providers with above-average prices are likely to face increased scrutiny.  In this study, we examined three research questions: How do the average charges for patients at America’s Essential Hospitals (AEH) member hospitals compare to other hospitals?; To what extent are these charge differences driven by differences in underlying costs?; What factors cause cost differences between AEH hospitals and other hospitals and among AEH member hospitals? We found that higher charges among AEH member hospitals are explained by higher costs, which in turn are explained by the intensive services these facilities provide and the environment in which they provide them.  If other hospitals operated under similar circumstances, the data suggests the costs would be similar, and the charges would be even higher than the current average charges among AEH members.

    Services : Advanced Data Analytics Expertise: , ,

    In a changing healthcare environment in which providers are under increasing demands to demonstrate their value, providers with above-average prices are likely to face increased scrutiny.  In this study, we examined three research questions: How do the average charges for patients at America’s Essential Hospitals (AEH) member hospitals compare to other hospitals?; To what extent

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  • Diagnosing Certain Conditions with Ultrasound over Other Technologies Can Save Money

    For certain types of conditions, different imaging technologies may serve as substitutes for one another. Rotator cuff tears, for example, can be diagnosed with ultrasound or magnetic resonance imaging (MRI).  Because both imaging technologies have been shown to be effective in diagnosing this type of injury, relative cost becomes an important consideration.  KNG Health conducted two studies to examine the potential cost savings to the Medicare program from the substitution of ultrasound for MRI and computed tomography (CT) in diagnosing certain musculoskeletal (MSK) conditions and renal colic. Cost-saving estimates were developed using Medicare claims data and assumptions relating to the use of diagnostic ultrasound, MRI, and CT in the Medicare population.  The studies found that using ultrasound over CT and MRI in diagnosing MSK conditions and renal colic would result in significant cost savings.

    Services : Advanced Data Analytics Expertise:

    For certain types of conditions, different imaging technologies may serve as substitutes for one another. Rotator cuff tears, for example, can be diagnosed with ultrasound or magnetic resonance imaging (MRI).  Because both imaging technologies have been shown to be effective in diagnosing this type of injury, relative cost becomes an important consideration.  KNG Health conducted

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  • Characteristics and Cost Drivers of High-Cost Hospitals

    A 2008 report produced by the Medicare Payment Advisory Commission (MedPAC) found that 20% of hospitals had consistently higher costs than other hospitals.  KNG Health identified key characteristics and cost drivers for those hospitals classified by MedPAC as high-cost hospitals.  The study compared low and high-cost hospitals across a number of dimensions, including hospital-wide and Medicare-specific cost factors, quality measures, and overall Medicare spending per beneficiary.  The study shows that, generally, high-cost hospitals have higher costs across multiple factors, but performed better on process-of-care quality measures than low-cost hospitals.

    Services : Advanced Data Analytics Expertise:

    A 2008 report produced by the Medicare Payment Advisory Commission (MedPAC) found that 20% of hospitals had consistently higher costs than other hospitals.  KNG Health identified key characteristics and cost drivers for those hospitals classified by MedPAC as high-cost hospitals.  The study compared low and high-cost hospitals across a number of dimensions, including hospital-wide and

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  • Patterns in the Use and Cost of Medical Care for Osteoarthritis Prior to Total Knee Arthroplasty: An Analysis of the Osteoarthritis Initiative and Medicare Data

    In this paper, we examined patterns in the use and costs of treatments for osteoarthritis (OA) of the knee in the years prior to total knee arthroplasty (TKA) and how these patterns differ between elderly and younger populations.  We examined treatments from one to five years prior to surgery for a cohort of individuals with osteoarthritis who received a TKA.    Using data from the Osteoarthritis Initiative and Medicare, we assessed the use of medications, corticosteroid and hyaluronic acid injections, arthroscopy, durable medical equipment, and office visits.  We found that the use and spending for services related to knee OA increased every year leading up to total knee arthroplasty, increasing almost 9 fold between one year prior to TKA and five years prior to TKA. Patients in our sample generated more spending on hyaluronic acid and corticosteroid injections than any other treatment category. The injections represented between 28.7% (five years prior to TKA) and 44.9% (two years prior to TKA) of the Medicare spending related to knee OA.  Nevertheless, use rates for most services remained relatively low, with the exception of pain-relieving medications.

    Services : Advanced Data Analytics Expertise:

    In this paper, we examined patterns in the use and costs of treatments for osteoarthritis (OA) of the knee in the years prior to total knee arthroplasty (TKA) and how these patterns differ between elderly and younger populations.  We examined treatments from one to five years prior to surgery for a cohort of individuals with

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  • Health and Spending Consequences of Bisphosphonate Treatment for Osteoporosis: A Markov Model Approach

    Osteoporosis-related hip fractures are a major source of avoidable disability and generate significant healthcare costs.  Although bisphosphonates use has been shown to prevent osteoporotic fractures, utilization has been low. This study assessed the value of bisphosphonates to patients and payers by estimating the health and spending consequences of treatment.  We ran Markov models to assess the effects of bisphosphonate treatment on hip fractures, long-term-care (LTC) facility admissions, life years, and medical and custodial care spending for females aged 65 and 75 with mild, moderate, and severe osteoporosis. Assumptions were developed using 2011-2013 Medicare claims, a mixed-effect meta-analysis of prior clinical studies, and literature review. For females age 75 with a high risk of osteoporotic hip fracture, bisphosphonate treatment would result in 4,965 fewer hip fractures per 100,000 people; and 2,982 avoided LTC admissions per 100,000 people. Over a 75 year old woman’s lifetime, bisphosphonate treatment decreases expected medical services spending ($US 2012) for hip fracture between $640 (mild risk) and $2,006 (high risk) (p<.05) and LTC spending by $1,785 (mild risk) and $5,816 (high risk) (p < .05). Despite the value of bisphosphonates to patients, their utilization remains low due, in part, to lack of patient education and insurance restrictions on injectable bisphosphonates. Increased utilization of bisphosphonate would reduce fractures and generate significant offsets to spending on bisphosphonates.

    Link to report:  Consequences of Bisphosphonate Treatment

    Services : Health Economics & Outcomes Research Expertise:

    Osteoporosis-related hip fractures are a major source of avoidable disability and generate significant healthcare costs.  Although bisphosphonates use has been shown to prevent osteoporotic fractures, utilization has been low. This study assessed the value of bisphosphonates to patients and payers by estimating the health and spending consequences of treatment.  We ran Markov models to assess

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