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  • Comparative Outcome and Market Analyses for Long Term Acute Care Hospitals

    KNG Health was contracted by a long-term care hospital (LTCH) to conduct a series of studies to better understand (1) the value of care provided by the hospital to patients in its market area; (2) the value it provides to short term acute care hospitals, and (3) referral patterns in its market.  To address these objectives, KNG Health conducted a series of studies using Medicare claims data.  In the first study, we compared mortality, readmissions, discharge to community, and Medicare spending per beneficiary between patients treated in the client’s LTCH to similar patients treated in other LTCHs and skilled nursing facilities (SNFs) in the same market area.  We used propensity score matching to construct a comparison group of patients who have similar clinical characteristics to the population of the LTCH examined.  In the second study, we conducted a market analysis that identifies the referral patterns among patient discharged from short-term acute care hospitals in the LTCH’s market area.  This analysis revealed the LTCH’s market share among cases that fulfill LTCH patient criteria as well as the share of cases that are referred to other providers.  The analysis was conducted for cases that fulfilled LTCH patient criteria, and the results were presented separately by MS-DRG.  In the third study, we predict cost savings that short-term acute care hospitals can experience by transferring their cases to the LTCH earlier.  We estimate a predictive model of average hospital costs and use the model’s results to predict cost savings under different counterfactual scenarios regarding length of stay.  The findings are incorporated into an interactive Excel tool that allows the user to identify predictions for different MS-DRGs and length of stays.

    Services : Health Economics & Outcomes Research Expertise: , ,

    KNG Health was contracted by a long-term care hospital (LTCH) to conduct a series of studies to better understand (1) the value of care provided by the hospital to patients in its market area; (2) the value it provides to short term acute care hospitals, and (3) referral patterns in its market.  To address these

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  • Comparison of Patients Treated in Hospital Outpatient Departments and Independent Physician Offices

    KNG Health is conducting a study to compare patients treated in hospital outpatient departments (HOPDs) and those treated in independent physician offices in terms of patient and visit characteristics.  The findings of the study will be used to inform the policy debate on whether payments to HOPDs and independent physician offices should be site neutral.  The study comprises of three sections.  First, we examine how patient populations treated in HOPDs and independent physician offices differ in terms of demographics, socioeconomic status, illness severity, and medical complexity.  Second, we examine differences in how the types of services and provider specialties differ between HOPDs and independent physician offices.  Third, we examine how patient and visit characteristics have changed over time in the two settings.  The data come from Medicare Inpatient, Outpatient, and Carrier Limited Data Sets for 5% of the Medicare beneficiaries.  The study is funded by the American Hospital Association.  KNG Health conducted an earlier version of this study limited to the cancer patient population in 2014.

    Services : Health Economics & Outcomes Research Expertise: , ,

    KNG Health is conducting a study to compare patients treated in hospital outpatient departments (HOPDs) and those treated in independent physician offices in terms of patient and visit characteristics.  The findings of the study will be used to inform the policy debate on whether payments to HOPDs and independent physician offices should be site neutral. 

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  • Assessing the Value of Home Health Care

    KNG Health has partnered with Excel Health to conduct an assessment of the value that home health care brings to Medicare beneficiaries discharged from a short-term acute care hospital.  About 30% of Medicare beneficiaries discharged from short-term acute care hospitals with instructions to receive home health care do not receive home health care.  The study exploits this variation in home health adherence among beneficiaries discharged with home health instructions to examine the effect of home health care on patient outcomes and Medicare expenditures.  Specifically, it examines hospital readmissions, mortality, Emergency Department visits, and Medicare spending over a 180-day post-acute care episode between beneficiaries who are adherent and those who are non-adherent with their instructions to receive home health care.  The data come from Medicare Inpatient, Outpatient, and Carrier Files available on the Virtual Research Data Center.  The outcome comparison is conducted using a risk adjustment model that accounts for differences in patient severity and medical complexity between the two patient groups.  The preliminary findings from the study were presented at a keynote session of the 2018 Elevating Home National Leadership Conference.

    Links: 2018 Elevating Home National Leadership Conference, Home Health Care News

    Services : Health Economics & Outcomes Research Expertise: , ,

    KNG Health has partnered with Excel Health to conduct an assessment of the value that home health care brings to Medicare beneficiaries discharged from a short-term acute care hospital.  About 30% of Medicare beneficiaries discharged from short-term acute care hospitals with instructions to receive home health care do not receive home health care.  The study

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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: Publication

    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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