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  • The Medicare Hospital Readmissions Reduction Program: Potential Unintended Consequences for Hospitals Serving Vulnerable Populations

    In this study, we explored the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations.  We used Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital’s share of duals, profit margin, and characteristics.  Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP.

    Both patient dual-eligible status and a hospital’s dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations.

    Links: Publication

    Services : Payment Policy & Delivery System Innovation, Program Evaluation and Monitoring, Quality & Performance Measurement Expertise: , ,

    In this study, we explored the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations.  We used Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital’s share of duals, profit margin, and characteristics.  Regression analyses and projections were used to estimate risk-adjusted

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  • State of the Long Term Care Hospital Sector: Access to Care for Medicare Beneficiaries

    In 2016, the Centers for Medicare & Medicaid Services (CMS) began phasing in new patient-level criteria, as established by Congress in the Pathway for SGR Reform Act of 2013.  In 2015, 54% of all LTCH Medicare fee-for-service (FFS) patients met the new criteria.  Although the full effects of the new criteria on access to LTCH care may not be known for some time, significant changes in reimbursement for cases not meeting the criteria (i.e., “site-neutral cases”) will force changes in the LTCH sector with potential implications for Medicare beneficiary access to the programs offered by these specialty hospitals.  In this report, we examined the current availability of LTCH care, how the availability of LTCH care has changed between 2009 and 2016, and how LTCH closures have affected utilization.  The study found: LTCHs treat beneficiaries from every state and one-third of LTCH patients travel to a different hospital referral region to receive LTCH care; 80% of Medicare beneficiaries reside in a hospital referral region with at least one LTCH and 90% live within 80 miles of an LTCH; since 2012, the LTCH market has been contracting and the current number of LTCHs and LTCH beds is now comparable to what it was in 2009.

    Links: Publication

    Services : Advanced Data Analytics, Payment Policy & Delivery System Innovation Expertise: ,

    In 2016, the Centers for Medicare & Medicaid Services (CMS) began phasing in new patient-level criteria, as established by Congress in the Pathway for SGR Reform Act of 2013.  In 2015, 54% of all LTCH Medicare fee-for-service (FFS) patients met the new criteria.  Although the full effects of the new criteria on access to LTCH

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  • The Effects of Long-Term Care Hospitals on Medical Spending and Patient Outcomes: A Review of the Literature

    For the National Association of Long Term Hospitals (NALTH), we conducted a systematic literature review on the effectiveness of receiving care in a long-term care hospital (LTCH).  We limited the search to studies published in English between January 1990 and August 2017. In addition to articles indexed in PubMed, we supplemented our review with reports from government agencies, studies from consultants and other subject matter experts, and articles identified from references of relevant published articles.  Our review identified only eight peer-reviewed studies assessing the impact of receiving care in an LTCH on spending and patient outcomes that met our inclusion and exclusion criteria and an additional six reports from government, consulting, and other entities. Among the 14 total publications, nine were comparative studies, which examined outcomes between patients treated in LTCHs and those in other settings. The literature supports the positive effects of LTCH care in terms of mortality, Medicare spending, and provider costs for some patient groups, particularly among the highest severity patients, such as those with extended ICU stays, those on a ventilator or with a tracheostomy, and those patients with multiple organ failure. However, the variability in results indicates the need for more research to better identify which patients are the best candidates for receiving care in an LTCH and what characteristics of LTCH care yield positive outcomes for patients.

    Services : Health Economics & Outcomes Research Expertise: , ,

    For the National Association of Long Term Hospitals (NALTH), we conducted a systematic literature review on the effectiveness of receiving care in a long-term care hospital (LTCH).  We limited the search to studies published in English between January 1990 and August 2017. In addition to articles indexed in PubMed, we supplemented our review with reports

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  • A Comparison of Outcomes between a High-Volume and Other Long-Term Care Hospitals in the Chicago Market: An Examination of Patients on Prolonged Mechanical Ventilation

    Long-term care hospitals (LTCHs) are an important post-acute care setting for patients who receive prolonged mechanical ventilation (PMV).  RML Specialty Hospital (RML), with campuses in Chicago and Hinsdale, IL, is an LTCH that cares for a disproportionate share of PMV patients in Chicago area.  In this study, we compare mortality, readmissions and Medicare payments for PMV patients treated in RML versus other LTCHs in the Chicago area.  The study population consisted of Medicare beneficiaries who experienced a STACH stay with PMV (MS-DRG: 3, 4) between March 2011 and June 2013 in the Chicago area and discharged to an LTCH.  Patients who discharged to RML immediately following the STACH stay constituted the treatment group.  We used propensity score matching to construct a comparison group consisting of patients with similar characteristics receiving care in other LTCHs after a STACH stay.  Among patients who were discharged with MS-DRG 3 from a STACH, those treated in RML had lower mortality and Medicare payments over 180-day episodes starting with admission to the STACH (p<0.05) compared to similar patients treated in other regional LTCHs.  RML patients with a STACH MS-DRG of 4 had similar 180-day mortality (p>0.05) but lower 180-day Medicare payments (p<0.05) compared to similar patients treated in other regional LTCHs.  The differences in readmission rates between RML patients and similar patients cared for in other regional LTCHs were not statistically significant (p>0.05).

    Links: Publication

    Services : Health Economics & Outcomes Research Expertise: , ,

    Long-term care hospitals (LTCHs) are an important post-acute care setting for patients who receive prolonged mechanical ventilation (PMV).  RML Specialty Hospital (RML), with campuses in Chicago and Hinsdale, IL, is an LTCH that cares for a disproportionate share of PMV patients in Chicago area.  In this study, we compare mortality, readmissions and Medicare payments for

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  • A Regional Analysis of Patient Outcomes and Medicare Payments for Sepsis Patients Treated in Long-Term Care Hospitals and Skilled Nursing Facilities

    In this study, we compare mortality, readmissions and Medicare payments for long-term care hospital (LTCH) patients who had a short-term acute care hospital (STACH) stay for sepsis and similar patients cared for in SNFs in the Chicago area. The study population consisted of Medicare beneficiaries who experienced an STACH stay for septicemia or severe sepsis (MS-DRG: 870, 871) between March 2011 and June 2013 in the Chicago area and were discharged to an LTCH or SNF.  Patients who were discharged to LTCHs immediately following the STACH stay constituted the treatment group.  We used propensity score matching to construct a comparison group consisting of patients with similar characteristics receiving care in SNFs after the STACH stay.  We did not find statistically significant differences in mortality and Medicare payments between LTCH and SNF patients over 180-day episodes of care that started at admission to STACH (p>0.05).  However, LTCH patients experienced lower readmission rates within 30-days after discharge from STACH when compared to SNF patients (LTCH patients: 14% vs. SNF patients: 29%, p<0.05).  The difference in 60- and 90-day readmission rates between the two groups is statistically insignificant (p>0.05).

    Links: Publication

    Services : Health Economics & Outcomes Research Expertise: , ,

    In this study, we compare mortality, readmissions and Medicare payments for long-term care hospital (LTCH) patients who had a short-term acute care hospital (STACH) stay for sepsis and similar patients cared for in SNFs in the Chicago area. The study population consisted of Medicare beneficiaries who experienced an STACH stay for septicemia or severe sepsis

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  • A Comparative Effectiveness Analysis of Care Received in a Long-Term Care Hospitals

    In recent years, there has been increasing interest in assessing the value of long-term care hospitals (LTCHs) to Medicare beneficiaries as researchers have observed that the LTCH patient population overlaps both with patients treated in step-down units of acute care hospitals and other settings. KNG Health conducted a comparative-effectiveness study of LTCH care using a quasi-experimental study design and Medicare inpatient claims data.  Among patients with multiple organ failure, the study reported lower mortality at similar or lower Medicare payment or lower Medicare payment at similar mortality in 4 of the 5 condition categories studied for patients cared for in an LTCH as compared to patients cared for at other settings. For patients with 3 or more days in an intensive care unit, LTCH care was associated with better outcomes in 3 of the 5 condition categories and ambiguous results for the remaining 2 categories (LTCH care is associated with lower mortality at higher Medicare payment).  The study results were published in Medical Care.

    Links: Publication

    Services : Health Economics & Outcomes Research Expertise: , ,

    In recent years, there has been increasing interest in assessing the value of long-term care hospitals (LTCHs) to Medicare beneficiaries as researchers have observed that the LTCH patient population overlaps both with patients treated in step-down units of acute care hospitals and other settings. KNG Health conducted a comparative-effectiveness study of LTCH care using a

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