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Factors associated with delivery sys...

Kaur, Ramandeep.

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Factors associated with delivery system performance using Medicare "bundled payments" criteria: A multi-level analysis.

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Factors associated with delivery system performance using Medicare "bundled payments" criteria: A multi-level analysis./
作者:	Kaur, Ramandeep.
出版者:	Ann Arbor : ProQuest Dissertations & Theses, : 2015,
面頁冊數:	122 p.
附註:	Source: Dissertation Abstracts International, Volume: 76-10(E), Section: A.
Contained By:	Dissertation Abstracts International76-10A(E).
標題:	Public policy. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3704085
ISBN:	9781321762501

Factors associated with delivery system performance using Medicare "bundled payments" criteria: A multi-level analysis.
Kaur, Ramandeep.

Factors associated with delivery system performance using Medicare "bundled payments" criteria: A multi-level analysis. - Ann Arbor : ProQuest Dissertations & Theses, 2015 - 122 p.

Source: Dissertation Abstracts International, Volume: 76-10(E), Section: A.

Thesis (Ph.D.)--Brandeis University, The Heller School for Social Policy and Management, 2015.

Factors associated with delivery system performance using Medicare "bundled payments" criteria: a multi- level analysis A dissertation presented to the Faculty of The Heller School for Social Policy and Management and the Graduate Faculty of Brandeis University Waltham, Massachusetts By Ramandeep Kaur After many years of having separate payment systems for hospitals and for each post-acute care (PAC) setting, the Medicare program has begun to develop and implement payment models that would bundle payments for inpatient care, physician services, and PAC services into a single payment for an episode of care. We evaluated the extent to which total episode spending was explained by differences in organizational relationships between hospitals and PAC providers as interpreted by referral patterns, rates of physician follow-up visits within 14-days of discharge, rates of follow-up visits with the hospital attending physician, and rates of follow-up visits with the original referring physician.

ISBN: 9781321762501Subjects--Topical Terms:

532803
Public policy.

Factors associated with delivery system performance using Medicare "bundled payments" criteria: A multi-level analysis.
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520 $a Factors associated with delivery system performance using Medicare "bundled payments" criteria: a multi- level analysis A dissertation presented to the Faculty of The Heller School for Social Policy and Management and the Graduate Faculty of Brandeis University Waltham, Massachusetts By Ramandeep Kaur After many years of having separate payment systems for hospitals and for each post-acute care (PAC) setting, the Medicare program has begun to develop and implement payment models that would bundle payments for inpatient care, physician services, and PAC services into a single payment for an episode of care. We evaluated the extent to which total episode spending was explained by differences in organizational relationships between hospitals and PAC providers as interpreted by referral patterns, rates of physician follow-up visits within 14-days of discharge, rates of follow-up visits with the hospital attending physician, and rates of follow-up visits with the original referring physician.
520 $a The data sources used in this study were 2008-2012 Medicare Part A and Part B claims, the Provider of Service file, the Healthcare Cost Report Information System, and the Dartmouth Atlas. The Medicare Bundled Payments for Care Improvement Initiative's specifications were adapted to define episodes of care for five health conditions selected for their high variation in PAC use and Medicare spending. We hypothesized that concentrating PAC placements among fewer providers would lead to lower episode allowed amounts, lower readmissions, and lower PAC use. These organizational relationships were measured by the concentration of each hospital's PAC referrals to the four most frequently used PAC providers. We also hypothesized that higher rates of timely physician follow-up visits, and continuity of physician care, would be associated with lower total episode allowed amounts. We developed multivariate regressions models for episode allowed amounts, readmission, and PAC use in order to assess the unique contributions of the hypothesized effects.
520 $a Consistent with expectations, results suggest that higher concentrations of a hospital's PAC referrals were associated with lower episode allowed amounts, lower odds of readmission, and lower odds of PAC use. Contrary to expectations, results suggest that higher rates of timely physician follow-up visits, physician visits with the referring physician, and physician visits with the hospital attending were associated with higher episode allowed amounts. The study reinforces the importance of limited networks for PAC services under bundling arrangements, but recommends further work to understand the mechanism that may link rates of physician follow-up visits to higher episode allowed amounts.
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