Poster 475 Predicting Readmissions to Acute Care Hospitals From Inpatient Rehabilitation Facilities in Medicare Fee-for-Service Stroke Patients

PM&R ◽  
2011 ◽  
Vol 3 ◽  
pp. S340-S341
Author(s):  
Margaret A. DiVita ◽  
Carl V. Granger ◽  
Samuel Markello ◽  
Paulette Niewczyk
Keyword(s):  
Acute Care ◽  
Inpatient Rehabilitation ◽  
Acute Care Hospitals ◽  
Fee For Service ◽  
Stroke Patients ◽  
Rehabilitation Facilities

Variation in 30-Day Readmission Rates from Inpatient Rehabilitation Facilities to Acute Care Hospitals

2021 ◽  
Author(s):  
Cristina A. Shea ◽  
Razvan Turcu ◽  
Bonny S. Wong ◽  
Michelle E. Brassil ◽  
Chloe S. Slocum ◽  
...  
Keyword(s):  
Acute Care ◽  
Inpatient Rehabilitation ◽  
Acute Care Hospitals ◽  
Readmission Rates ◽  
Rehabilitation Facilities

Medicare bundles for arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 119-125
Author(s):  
Bryan D. Springer ◽  
Jordan McInerney
Keyword(s):  
Acute Care ◽  
Acute Care Hospitals ◽  
Drop Out ◽  
Retention Rates ◽  
Fee For Service ◽  
Target Price ◽  
High Performing ◽  
Bundled Payment ◽  
Bundled Payments ◽  
Care Improvement

Aims There is concern that aggressive target pricing in the new Bundled Payment for Care Improvement Advanced (BPCI-A) penalizes high-performing groups that had achieved low costs through prior experience in bundled payments. We hypothesize that this methodology incorporates unsustainable downward trends on Target Prices and will lead to groups opting out of BPCI Advanced in favour of a traditional fee for service. Methods Using the Centers for Medicare and Medicaid Services (CMS) data, we compared the Target Price factors for hospitals and physician groups that participated in both BPCI Classic and BPCI Advanced (legacy groups), with groups that only participated in BPCI Advanced (non-legacy). With rebasing of Target Prices in 2020 and opportunity for participants to drop out, we compared retention rates of hospitals and physician groups enrolled at the onset of BPCI Advanced with current enrolment in 2020. Results At its peak in July 2015, 342 acute care hospitals and physician groups participated in Lower Extremity Joint Replacement (LEJR) in BPCI Classic. At its peak in March 2019, 534 acute care hospitals and physician groups participated in LEJR in BPCI Advanced. In January 2020, only 14.5% of legacy hospitals and physician groups opted to stay in BPCI Advanced for LEJR. Analysis of Target Price factors by legacy hospitals during both programmes demonstrates that participants in BPCI Classic received larger negative adjustments on the Target Price than non-legacy hospitals. Conclusion BPCI Advanced provides little opportunity for a reduction in cost to offset a reduced Target Price for efficient providers, as made evident by the 85.5% withdrawal rate for BPCI Advanced. Efficient providers in BPCI Advanced are challenged by the programme’s application of trend and efficiency factors that presumes their cost reduction can continue to decline at the same rate as non-efficient providers. It remains to be seen if reverting back to Medicare fee for service will support the same level of care and quality achieved in historical bundled payment programmes. Cite this article: Bone Joint J 2021;103-B(6 Supple A):119–125.

scholarly journals 1153. National Trend of Urinary Catheter Device Utilization by Hospital Type, National Healthcare Safety Network (2015–2019)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S411-S412
Author(s):  
Minn M Soe
Keyword(s):  
Acute Care ◽  
Negative Binomial ◽  
Urinary Catheter ◽  
Inpatient Rehabilitation ◽  
Acute Care Hospitals ◽  
Equation Modeling ◽  
Quality Reporting ◽  
Factors Associated ◽  
National Healthcare ◽  
National Healthcare Safety Network

Abstract Background Reducing unnecessary urinary catheter use and optimizing insertion techniques and catheter maintenance and care practices are the most important urinary tract infection (CAUTI) prevention strategies. To monitor device use (DU) as quality improvement activity, the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) developed the risk adjusted, standardized urinary catheter device utilization ratio in 2015. This study aims to assess national trends of DU from the baseline year 2015 through 2019. Methods For our trend analysis, we analyzed DU data (catheter days per 100 inpatient-days) that acute care hospitals (ACHs), long-term acute care hospitals (LTACHs), inpatient rehabilitation facilities (IRFs), and critical access hospitals (CAHs) reported to NHSN from 2015Q1 through 2019Q1. The ward and intensive care unit patient care locations included in our analysis are those that ACHs, LTACHs, IRFs and CAHs are required to report to CMS to comply with CMS Inpatient Quality Reporting program requirements. We regressed DU by quarterly period using generalized estimating equation modeling with the negative-binomial distribution, after adjusting for factors associated with corresponding SUR models of 2015 baseline and accounting for autocorrelation of error terms within a location. For graphic display, we also computed quarterly DU using marginal predictive models. Results The DU decreased over time (P ≤ 0.05, average percent change per quarter (%change): −0.54 [95% CI: −0.54, −0.53]) among ACHs (Table 1, Figure 1), and −0.54 [95% CI: −0.58, −0.49] among LTACHs (Table 1, Figure 2). Among IRFs, quarterly DU in 2015Q2–2016Q3 were similar relative to 2015Q1, but decreased from 2016Q4 onward (P ≤ 0.05, % change: −0.51 [95% CI: −0.61, −0.40]) (Table 1, Figure 3). Among CAHs, quarterly DU in 2015Q2–2016Q4 were similar relative to 2015Q1, but decreased from 2017Q1 onward (P ≤ 0.05, % change: −0.22 [95% CI: −0.39, −0.04]) (Table 1, Figure 4). Conclusion There was a statistically significant decrease in National DU of urinary catheter during 2015–2019 across NHSN, although the magnitude of change per quarter was not large. Further research is needed to explore causal factors associated with such reduction. Disclosures All authors: No reported disclosures.

Abstract T P117: Impact of Medicaid Coverage on Utilization of Inpatient Rehabilitation Facilities

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Lesli Skolarus ◽  
James F Burke ◽  
Lewis B Morgenstern ◽  
Will Meurer ◽  
Eric Adelman ◽  
...  
Keyword(s):  
Acute Care ◽  
Private Insurance ◽  
Inpatient Rehabilitation ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Medicaid Coverage ◽  
Random Intercept ◽  
Working Age ◽  
Medicaid Population ◽  
Post Acute Care

Objective: Optimal post-acute care is associated with improved stroke outcomes. Among working age stroke patients discharged to institutional post-acute care, those with Medicaid are less likely to be discharged to an inpatient rehabilitation facility (IRF) than those with private insurance, a finding which may be influenced by state Medicaid coverage. We hypothesized that stroke patients residing in states where Medicaid does not cover IRFs would be less likely to be discharged to an IRF than patients residing in states where Medicaid covers IRFs. Methods: Working age ischemic stroke patients with Medicaid were identified from the 2010 Nationwide Inpatient Sample (NIS) using ICD-9 CM codes 433.x1, 434.x1 and 436. Medicaid coverage of IRFs (yes versus no) was ascertained for 45 states with NIS data by review of state Medicaid websites. The primary outcome was discharge to IRF (versus other discharge destinations). We fit a hierarchical logistic regression model that included patient-level factors (demographics and stroke severity measures (length of stay, t-PA use and Charlson comorbidity score)), and a state policy variable representing whether a State’s Medicaid pays for IRF, with a random intercept for hospital. Based on this model, we estimated the probability of utilization of IRFs in states with Medicaid coverage of IRFs compared to those without. Results: Medicaid did not cover IRFs in 4 (TN, TX, SC, WV) out of 45 states. Compared to stroke patients residing in states with Medicaid coverage of IRF, stroke patients hospitalized in states without Medicaid coverage of IRF were less likely to be discharged to an IRF (12.8% (7.5-18.0%) vs. 19.4% (17.0-21.8%), p=0.02) after adjusting for patient and hospital factors. Conclusion: Working age stroke patients with Medicaid who reside in states where Medicaid does not cover IRFs have less utilization of IRFs than patients residing in states where Medicaid covers IRFs. As the Medicaid population expands under the Patient Protection and Affordable Care Act and the number of working age stroke patients increase, careful attention to state Medicaid policy for post-acute care and analysis of its effects are warranted.

scholarly journals Relationship between Three-year Survival and Functional Outcome at Discharge from Acute-care Hospitals in Each Subtype of First-ever Ischemic Stroke Patients

2011 ◽  
Vol 50 (13) ◽  
pp. 1377-1383 ◽  
Author(s):  
Yutaka Suto ◽  
Hisanori Kowa ◽  
Hiroyuki Nakayasu ◽  
Etsuko Awaki ◽  
Jun Saito ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Stroke Patients

Predictors of Discharge to Acute Care after Inpatient Rehabilitation in Severely Affected Stroke Patients

2012 ◽  
pp. 1
Author(s):  
Duc M. Chung ◽  
Paulette Niewczyk ◽  
Margaret DiVita ◽  
Sam Markello ◽  
Carl Granger
Keyword(s):  
Acute Care ◽  
Inpatient Rehabilitation ◽  
Stroke Patients

scholarly journals How Do the Hospital Prices Paid by Medicare Advantage Plans and Commercial Plans Compare With Medicare Fee-for-Service Prices?

2018 ◽  
Vol 55 ◽  
pp. 004695801877965
Author(s):  
Jared Lane K. Maeda ◽  
Lyle Nelson
Keyword(s):  
Health Care ◽  
Acute Care ◽  
Health Care Cost ◽  
Acute Care Hospitals ◽  
Fee For Service ◽  
Medicare Advantage ◽  
Medicare Beneficiaries ◽  
Metropolitan Statistical Areas

The prices that private insurers pay hospitals have received considerable attention in recent years, but most of that literature has focused on the commercially insured population. Although nearly one-third of Medicare beneficiaries are enrolled in a Medicare Advantage (MA) plan, little is known about the prices paid to hospitals by the private insurers that administer such plans. More information on the hospital prices paid by MA plans would provide additional insights into whether MA prices are more closely tied to Medicare fee-for-service (FFS) prices or commercial prices. Moreover, information on whether the hospital prices paid by MA plans vary with market characteristics or other factors would be useful for evaluating the performance of the MA program and analyzing proposals to modify it. In this study, we compared the hospital prices paid by MA plans and commercial plans with Medicare FFS prices using 2013 claims from the Health Care Cost Institute (HCCI) database. The HCCI claims were used to calculate hospital prices for private insurers, and Medicare’s payment rules were used to estimate Medicare FFS prices. We focused on stays at acute care hospitals in metropolitan statistical areas (MSAs). We found MA prices to be roughly equal to Medicare FFS prices, on average, but commercial prices were 89% higher than FFS prices. In addition, commercial prices varied greatly across and within MSAs, but MA prices varied much less.

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