Racial Differences in Post-Acute Utilization After Hip Fracture in Medicare Beneficiaries With ADRD

Abstract BACKGROUND: The incidence of hip fracture in patients with Alzheimer’s disease and related dementias (ADRD) is 2.7 times higher than it is in those without ADRD. Care complexity, including extensive post-acute rehabilitation, increases substantially in patients with ADRD after hip fracture. However, there are no standardized post-acute care utilization models for patients with ADRD after hip fracture. Additionally, there is a lack of knowledge on how post-acute utilization varies by race/ethnicity, in this population. OBJECTIVES: To investigate racial differences in post-acute care utilization following hip fracture related hospitalization in patients with ADRD. METHODS: A secondary analysis was conducted on 120,179 older adults with ADRD with incident hip fracture, using 100% Medicare data (2016-2017). The primary outcome was post-acute discharge dispositions (skilled nursing facility [SNF], inpatient rehabilitation facility [IRF], and Home Health Care [HHC]) across various racial groups. Multinomial logistic regression examined the association between race and post-acute discharge dispositions after accounting for patient-level covariates. RESULTS: Compared to non-Hispanic Whites, minority racial groups have significantly lower odds of being discharged to SNF, IRF, or HHC, as compared to home. Adjusted odds ratio for Hispanics discharged to SNF was 0.28 (CI=0.24-0.31), to IRF was 0.46 (CI=0.39-0.52) and HHC was 0.64 (95% CI =0.54-0.75), as compared to home. CONCLUSION: ADRD patients have higher risk of hip fracture. Findings from this study will provide insight on how to reduce racial and ethnic disparities in post-acute care utilization in vulnerable populations and improve quality of care and health outcomes.

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Racial Differences in Post-Acute Transition After Hip Fracture in Medicare Patients With ADRD

Innovation in Aging ◽

10.1093/geroni/igaa057.2307 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 666-667

Author(s):

Indrakshi Roy ◽

Amol Karmarkar ◽

Amit Kumar ◽

Meghan Warren ◽

Patricia Pohl ◽

...

Keyword(s):

Hip Fracture ◽

Racial Differences ◽

Home Health Care ◽

Multinomial Logistic Regression ◽

Skilled Nursing Facility ◽

Ethnic Disparities ◽

Inpatient Rehabilitation ◽

Patient Characteristics ◽

Nursing Facility ◽

Skilled Nursing

Abstract The incidence of hip fractures in patients with Alzheimer’s disease and related dementias (ADRD) is 2.7 times higher than it is in those without ADRD. However, there are no standardized post-acute transition models for patients with ADRD after hip fracture. Additionally, there is a lack of knowledge on how post-acute transitions vary by race/ethnicity. Using 100% Medicare data (2016-2017) for 120,179 older adults with ADRD, we conduct multinomial logistic regression, to examine the association between race and post-acute discharge locations (proportion discharged to skilled nursing facility [SNF], inpatient rehabilitation facility [IRF], and Home with Home Health Care [HHC]), after accounting for patient characteristics. Compared to non-Hispanic Whites, Hispanics have a significantly lower odds ratio for discharge to HHC 0.62 (95%CI=0.53-0.73), IRF 0.44 (CI=0.39-0.51), and SNF 0.26 (CI=0.23-0.30). Improving care in patients with ADRD and reducing racial and ethnic disparities in quality of care and health outcomes will be discussed.

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Post-Acute Care Utilization and Episode of Care Payments Following Common Elective Operations

Annals of Surgery ◽

10.1097/sla.0000000000004814 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Anne P Ehlers ◽

Ryan Howard ◽

Yen-ling Lai ◽

Jennifer F. Waljee ◽

Lia D. Delaney ◽

...

Keyword(s):

Acute Care ◽

Care Utilization ◽

Episode Of Care ◽

Acute Care Utilization ◽

Post Acute Care

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The Effect of Hospital Safety Net Status on the Association Between Bundled Payment Participation and Changes in Medical Episode Outcomes

Journal of Hospital Medicine ◽

10.12788/jhm.3722 ◽

2021 ◽

Author(s):

Joshua M Liao ◽

Paula Chatterjee ◽

Erkuan Wang ◽

John Connolly ◽

Jingsan Zhu ◽

...

Keyword(s):

Acute Care ◽

Low Income ◽

Safety Net ◽

Care Utilization ◽

Difference In Differences ◽

Bundled Payment ◽

Hospital Safety ◽

Percentage Points ◽

Acute Care Utilization ◽

Post Acute Care

BACKGROUND: Under Medicare’s Bundled Payments for Care Improvement (BPCI) program, hospitals have maintained quality and achieved savings for medical conditions. However, safety net hospitals may perform differently owing to financial constraints and organizational challenges. OBJECTIVE: To evaluate whether hospital safety net status affected the association between bundled payment participation and medical episode outcomes. DESIGN, SETTING, AND PARTICIPANTS: This observational difference-in-differences analysis was conducted in safety net and non–safety net hospitals participating in BPCI for medical episodes (BPCI hospitals) using data from 2011-2016 Medicare fee-for-service beneficiaries hospitalized for acute myocardial infarction, pneumonia, congestive heart failure, and chronic obstructive pulmonary disease. EXPOSURE(S): Hospital BPCI participation and safety net status. MAIN OUTCOME(S) AND MEASURE(S): The primary outcome was postdischarge spending. Secondary outcomes included quality and post–acute care utilization measures. RESULTS: Our sample consisted of 803 safety net and 2263 non–safety net hospitals. Safety net hospitals were larger and located in areas with more low-income individuals than non–safety net hospitals. Among BPCI hospitals, safety net status was not associated with differential postdischarge spending (adjusted difference-in-differences [aDID], $40; 95% CI, –$254 to $335; P = .79) or quality (mortality, readmissions). However, BPCI safety net hospitals had differentially greater discharge to institutional post–acute care (aDID, 1.06 percentage points; 95% CI, 0.37-1.76; P = .003) and lower discharge home with home health (aDID, –1.15 percentage points; 95% CI, –1.73 to –0.58; P < .001) than BPCI non–safety net hospitals. CONCLUSIONS: Under medical condition bundles, safety net hospitals perform differently from other hospitals in terms of post–acute care utilization, but not spending. Policymakers could support safety net hospitals and consider safety net status when evaluating bundled payment programs.

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Post-Acute Care for Medicare Beneficiaries in Accountable Care Organizations

Innovation in Aging ◽

10.1093/geroni/igaa057.061 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 19-19

Author(s):

Erin Colligan ◽

Brittany Branand

Keyword(s):

Acute Care ◽

Inpatient Rehabilitation ◽

Cost Of Care ◽

Accountable Care Organizations ◽

Care Utilization ◽

Accountable Care ◽

Total Cost ◽

Transitions In Care ◽

The Impact ◽

Post Acute Care

Abstract Post-acute care (PAC) is a component of health-care utilization and spending that is subject to the discretion of providers. Prior research has demonstrated that Accountable Care Organizations (ACOs) recognize PAC as a logical target for increased efficiency and cost savings. As part of the evaluation of the Centers for Medicare & Medicaid Services (CMS) Next Generation ACO (NGACO) Model, we investigated NGACOs’ approaches to PAC services and the impact of these efforts on utilization and cost using a mixed-methods study design. We conducted interviews and surveys with NGACO leadership and providers and performed a difference-in-differences analysis of utilization and spending based on Medicare claims data. We found that NGACOs focused specifically on establishing partnerships with skilled nursing facilities (SNF) to facilitate transitions in care by establishing new channels of communication, sharing performance data, embedding staff in SNFs, and (in some cases) sharing financial risk. We observed a statistically significant decrease in SNF spending, a trend toward fewer SNF days, and statistically significantly lower expenditures for other PAC settings (e.g., inpatient rehabilitation and long-term acute care facilities). These findings suggest that NGACOs have contributed to improving transitions in care and diverting beneficiaries from intensive PAC settings. Nonetheless, the reduction in PAC spending alone did not translate to a decline in total cost of care. Future ACOs may need to expand their focus to the inpatient utilization and spending that precedes PAC in order to impact total cost of care.

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