Dataset Information

Association Between Medicare Policy Reforms and Changes in Hospitalized Medicare Beneficiaries' Severity of Illness.

ABSTRACT:

Importance

The measured severity of illness of hospitalized Medicare beneficiaries has increased. Whether this change is associated with payment reforms, concentrated among hospitalizations with principal diagnoses targeted by payment reform, and reflective of true increases in severity of illness is unknown.

Objectives

To assess whether the expansion of secondary diagnosis codes in January 2011 and the incentive payments for health information technology under the US Health Information Technology for Economic and Clinical Health Act were associated with changes in measured severity of illness and whether those changes are reflective of true increases in underlying patient severity.

Design, setting, and participants

This cohort study of Medicare fee-for-service beneficiary discharges (N?=?47?951?443) between January 1, 2008, and August 31, 2015, used a regression-discontinuity design to evaluate changes in measured severity of illness after the expansion of secondary diagnoses. Discharge-level linear regression model with hospital fixed effects was used to evaluate changes in measured severity of illness after hospitals' receipt of incentives for health information technology. The change in predictive accuracy of measured severity of illness on 30-day readmissions after the implementation of both policies was evaluated. Data analysis was performed from November 1, 2018, to March 5, 2019.

Main outcomes and measures

The primary outcome was patients' measured severity of illness determined by the number of condition categories from secondary discharge diagnosis codes. Measured severity of illness for diagnoses commonly targeted by Medicare policies and untargeted diagnoses was assessed.

Results

In total, 47?951?443 discharges at 2850 hospitals were included. In 2008, these beneficiaries included 3?882?672 women (58.5%) with a mean (SD) age of 78.5 (8.4) years. In 2014, the discharges included 3?377?137 women (57.8%) with the mean (SD) age of 78.4 (8.7) years. The Centers for Medicare & Medicaid Services expansion of secondary diagnoses was associated with a 0.348 (95% CI, 0.328-0.367; P?Conclusions and relevanceChanges in Centers for Medicare & Medicaid Services policies appear to be associated with increases in measured severity of illness; these increases do not appear to reflect substantive changes in true patient severity.

SUBMITTER: Sukul D

PROVIDER: S-EPMC6503517 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Association Between Medicare Policy Reforms and Changes in Hospitalized Medicare Beneficiaries' Severity of Illness.

Sukul Devraj D Hoffman Geoffrey J GJ Nuliyalu Ushapoorna U Adler-Milstein Julia R JR Zhang Bill B Dimick Justin B JB Ryan Andrew M AM

JAMA network open 20190503 5

<h4>Importance</h4>The measured severity of illness of hospitalized Medicare beneficiaries has increased. Whether this change is associated with payment reforms, concentrated among hospitalizations with principal diagnoses targeted by payment reform, and reflective of true increases in severity of illness is unknown.<h4>Objectives</h4>To assess whether the expansion of secondary diagnosis codes in January 2011 and the incentive payments for health information technology under the US Health Infor ...[more]

PMID: 31050779

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Dataset Information

Association Between Medicare Policy Reforms and Changes in Hospitalized Medicare Beneficiaries' Severity of Illness.

Importance

Objectives

Design, setting, and participants

Main outcomes and measures

Results

Publications

Association Between Medicare Policy Reforms and Changes in Hospitalized Medicare Beneficiaries' Severity of Illness.

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