In this study of postacute care, more than 10% of Medicare skilled nursing facility (SNF) stays included no visit from
a physician or advanced practitioner. Of stays with visits, about half of initial assessments occurred within a day of
admission, and nearly 80% occurred within four days. Patients who did not receive a visit from a physician or advanced
practitioner were nearly twice as likely to be readmitted to a hospital (28%) or to die (14%) within 30 days of SNF
admission than patients who had an initial visit.
Patient Outcomes After Hospital Discharge to Home with Home Health Care vs to a Skilled Nursing Facility
In this study of more than 17 million Medicare hospitalizations between 2010 and 2016, patients discharged to home
health care had a 5.6 percent higher 30-day readmission rate than similar patients discharged to a skilled nursing facility
(SNF). There was no difference in mortality or functional outcomes between the two groups, but home health care was
associated with an average savings of $4,514 in total Medicare payments in the 60 days after the first hospital admission.
Health system reforms, such as value-based payment, can worsen or improve existing health care disparities, even if policy changes do not target the disparities themselves.
National Representativeness Of Hospitals And Markets In Medicare's Mandatory Bundled Payment Program.
Abstract [from journal]
In 2016 Medicare implemented its first mandatory alternative payment model, the Comprehensive Care for Joint Replacement (CJR) program, in which the agency pays clinicians and hospitals a fixed amount for services provided in hip and knee replacement surgery episodes. Medicare made CJR mandatory, rather than voluntary, to produce generalizable evidence on what results Medicare might expect if it scaled bundled payment up nationally. However, it is unknown how markets and hospitals in CJR compare to others nationwide, particularly with respect to...
Changes to Racial Disparities in Readmission Rates After Medicare’s Hospital Readmissions Reduction Program Within Safety-Net and Non-Safety-Net Hospitals
After the Medicare Hospital Readmissions Reduction Program began enforcing financial penalties, disparities in readmissions between white and black patients widened at safety-net hospitals for conditions not targeted by the program. Disparities were stable for conditions targeted by the program. At non-safety-net hospitals, disparities were unchanged for both targeted and non-targeted conditions.
Joshua M. Liao and Amol S.
Joshua M. Liao and Amol S.
Joshua M. Liao, Anders Chen, and Amol S.
A review of the evidence shows that bundled payments for surgical procedures can generate savings without adversely affecting patient outcomes. Less is known about the effect of bundled payments for chronic medical conditions, but early evidence suggests that cost and quality improvements may be small or non-existent. There is little evidence that bundles reduce access and equity, but continued monitoring is required.
ABSTRACT [FROM JOURNAL]
Selective contracting is an increasingly popular tool for reducing health care costs, but these savings must be weighed against consumer surplus losses from restricted access. In both public and private prescription drug insurance plans, issuers utilize preferred pharmacy networks to reduce drug prices. We show that, in the Medicare Part D program, drug plans with more restrictive preferred pharmacy networks, and plans with fewer enrollees who are insensitive to preferred pharmacy discounts on copays, pay lower retail drug prices. We then use estimates of...