Total Estimated Medicare Spending Per Beneficiary - Post-Acute Care
Identifying Attributes
Care Settings
Country
Publishing Organisation
Type of Quality Indicator
IOM Quality Dimension
Domain
Defining Attributes
Definition
The assessment of the Medicare spending of a home health agency's Medicare Spending Per Beneficiary - Post-Acute Care (MSPB-PAC) home health episodes, relative to the Medicare spending of the national median home health agency s MSPB-PAC home health episodes across the same performance period. Note: An MSPB-PAC home health measure score of less than 1 indicates that a given home health agency s resource use is less than that of the national median home health agency during the same performance period.
Numerator
The numerator is called the MSPB-PAC Amount. This is the average observed over expected (as predicted through risk adjustment) Medicare spending for a home health agency s MSPB-PAC home health episodes, multiplied by the national average MSPB-PAC home health spending.
Denominator
The denominator for MSPB-PAC measure is the episode-weighted national median of the MSPB-PAC Amounts across all home health agencies.
Exclusions
Episodes triggered by a claim outside the 50 states, D.C., Puerto Rico, and U.S. territories Episodes where the claim(s) constituting the attributed home health agency s treatment have a standard allowed amount of zero or where the standard allowed amount cannot be calculated. Episodes where the patient is not continuously enrolled in Medicare FFS for the 90 days before the episode trigger (lookback period) through to the end of the episode window, or is enrolled in Part C for any part of this period. This includes cases where the beneficiary dies during this period. Episodes in which a patient has a primary payer other than Medicare during the 90-day lookback period or episode window Episodes where the claim(s) constitution the attributed home health agency's treatment include a non-PPS related condition code Episodes triggered by a RAP claim Episodes with outlier residuals below the 1st percentile or above the 99th percentile of the residual distribution.
Use of Risk Adjustment
Risk Adjustments
The MSPB-PAC models use a linear regression framework and a 90-day HCC lookback period. Adjusted for health status as per the CMS Hierarchical Condition Categories framework, age at the start of the episode, Original entitlement to Medicare through disability, ESRD, Long-term care institutionalization at start of episode, clinical case mix categories reflecting recent prior care, Hospice utilisation during the episode, Prior acute ICU utilisation day categories, Prior acute length of stay categories.
Stratifications
None
Data Attributes
Type of Data Collection
Data Collection Methods
Medicare fee-for-service (FFS) claims data.. Uses a 90-day lookback period
Frequency of Data Collection
Frequency of Data Collection in Days
Reporting Methods
Home Health Quality Reporting (CMS and providers) CMS Care Compare - Home health services and CMS Provider Compare (CMS, providers and publicly reported online) Included in the Quality of Patient Care star rating algorithm (CMS, providers and publicly reported online).