Christopher Lau1, Abby Alpert2, Peter Huckfeldt3, Peter Hussey3, David Auerbach3, Hangsheng Liu3, Neeraj Sood4, Ateev Mehrotra5. 1. Pardee RAND Graduate School, United States. 2. Paul Merage School of Business, University of California, Irvine, United States. 3. RAND Corporation, United States. 4. Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, United States; Titus Family Department of Clinical Pharmacy, Pharmaceutical Economics & Policy, University of Southern California, United States. 5. Harvard Medical School, 180 Longwood Avenue, Boston, MA02115, United States. Electronic address: mehrotra@hcp.med.harvard.edu.
Abstract
BACKGROUND: Under new bundled payment models, hospitals are financially responsible for post-acute care delivered by providers such as skilled nursing facilities (SNFs) and home health agencies (HHAs). The hope is that hospitals will use post-acute care more prudently and better coordinate care with post-acute providers. However, little is known about existing patterns in hospitals׳ referrals to post-acute providers. METHODS: Post-acute provider referrals were identified using SNF and HHA claims within 14 days following hospital discharge. Hospital post-acute care network size and concentration were estimated across hospital types and regions. The 2008 Medicare Provider Analysis and Review claims for acute hospitals and SNFs, and the 100% HHA Standard Analytic Files were used. RESULTS: The mean post-acute care network size for U.S. hospitals included 57.9 providers with 37.5 SNFs and 23.4 HHAs. The majority of these providers (65.7% of SNFs, 60.9% of HHAs) accounted for 1 percent or less of a hospital׳s referrals and classified as "low-volume". Other post-acute providers we classified as routine. The mean network size for routine providers was greater for larger hospitals, teaching hospitals and in regions with higher per capita post-acute care spending. CONCLUSIONS: The average hospital works with over 50 different post-acute providers. Moreover, the size of post-acute care networks varies considerably geographically and by hospital characteristics. These results provide context on the complex task hospitals will face in coordinating care with post-acute providers and cutting costs under new bundled payment models.
BACKGROUND: Under new bundled payment models, hospitals are financially responsible for post-acute care delivered by providers such as skilled nursing facilities (SNFs) and home health agencies (HHAs). The hope is that hospitals will use post-acute care more prudently and better coordinate care with post-acute providers. However, little is known about existing patterns in hospitals׳ referrals to post-acute providers. METHODS: Post-acute provider referrals were identified using SNF and HHA claims within 14 days following hospital discharge. Hospital post-acute care network size and concentration were estimated across hospital types and regions. The 2008 Medicare Provider Analysis and Review claims for acute hospitals and SNFs, and the 100% HHA Standard Analytic Files were used. RESULTS: The mean post-acute care network size for U.S. hospitals included 57.9 providers with 37.5 SNFs and 23.4 HHAs. The majority of these providers (65.7% of SNFs, 60.9% of HHAs) accounted for 1 percent or less of a hospital׳s referrals and classified as "low-volume". Other post-acute providers we classified as routine. The mean network size for routine providers was greater for larger hospitals, teaching hospitals and in regions with higher per capita post-acute care spending. CONCLUSIONS: The average hospital works with over 50 different post-acute providers. Moreover, the size of post-acute care networks varies considerably geographically and by hospital characteristics. These results provide context on the complex task hospitals will face in coordinating care with post-acute providers and cutting costs under new bundled payment models.
Authors: Shravani Pathak; Daniel Snyder; Thomas Kroshus; Aakash Keswani; Prakash Jayakumar; Kelly Esposito; Karl Koenig; David Jevsevar; Kevin Bozic; Calin Moucha Journal: Clin Orthop Relat Res Date: 2019-09 Impact factor: 4.176
Authors: Peter J Huckfeldt; Lianna Weissblum; José J Escarce; Pinar Karaca-Mandic; Neeraj Sood Journal: Health Serv Res Date: 2018-08-15 Impact factor: 3.402