An Administrative Claims Measure of Payments Made for Medicare Patients for a 30-Day Episode of Care for Acute Myocardial Infarction

Abstract

This study introduces a claims-based measure of RSP for an AMI 30-day episode of care. The RSP varies among hospitals, with a 2-fold range in payments. When combined with quality measures, this payment measure will help profile high-value care.

Association of in-hospital resource utilization with post-acute spending in Medicare beneficiaries hospitalized for acute myocardial infarction: a cross-sectional study

“…In brief, the RSP measure is determined by calculating payments during the 30-day AMI episode of care after removing payment adjustments for policy initiatives and geographic factors to better reflect variation in resource utilization related to clinical care. Payments were then risk-standardized based on patient clinical characteristics in the AMI hospitalization and the 12 months before hospitalization [14, 15].…”

Variation in and Hospital Characteristics Associated With the Value of Care for Medicare Beneficiaries With Acute Myocardial Infarction, Heart Failure, and Pneumonia

“…We defined the study samples consistent with the CMS methods for public reporting, the details of which have been published previously. 5 , 6 , 7 , 8 , 9 , 10 , 11 The mortality and payment cohorts were restricted to patients enrolled in both Medicare Parts A and B for the 12 months before admission to maximize the ability to risk adjust for patient case mix. Patients who died during the index admission or in the 30-day episode interval were included in both cohorts.…”

“…5 , 6 , 7 More recently, the CMS began publicly reporting hospital-level 30-day risk-standardized payments (RSPs) for AMI (in 2014) and HF and PNA (in 2015). 8 , 9 , 10 , 11 These measures, all of which have been endorsed by the National Quality Forum, 12 , 13 , 14 provide a prime opportunity for empirical assessments of the value of care for these clinical conditions.…”

Hospital variation in cost of childbirth and contributing factors: a cross‐sectional study

“…All 35 maternal and fetal clinical risk factors were considered as candidate risk‐adjustors and those that were significant at P < 0.20 level were retained in the final model (see Table S2). Based on results from this hierarchical generalised linear model model and applying a method similar to the approach used by the Centers for Medicare and Medicaid Services in benchmarking hospital performance on resource use, we calculated a risk‐standardised cost for each hospital accounting for its patient case‐mix and hospital‐specific effect (see Appendix S1, for more technical details).…”