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Research Letter |

Association of Postdischarge Spending and Performance on New Episode-Based Spending Measure

Anup Das, BA1; Edward C. Norton, PhD1; David C. Miller, MD, MPH2; Lena M. Chen, MD, MS3
[+] Author Affiliations
1Department of Health Management and Policy, University of Michigan, Ann Arbor
2Department of Urology, University of Michigan, Ann Arbor
3Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
JAMA Intern Med. 2016;176(1):117-119. doi:10.1001/jamainternmed.2015.6261.
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This CMS database study suggests that hospitals that can reduce postdischarge spending may perform better on CMS’ new spending measure.

The Centers for Medicare & Medicaid Services (CMS) is incentivizing hospitals to provide high-quality, low-cost care.1 As part of these efforts, CMS recently added the Medicare Spending per Beneficiary (MSPB) metric to its Hospital Value-Based Purchasing (HVBP) program, marking the first time that most US hospitals have received financial penalties or rewards based on their performance on a risk-adjusted, price-standardized 30-day episode-based measure of Medicare spending along with quality measures. The factors that influence or determine hospital performance in this metric have not yet been thoroughly investigated. We evaluated whether hospital performance was driven by spending before, during, or after hospitalization.

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Changes in Episode Spending for Hospitals That Performed Worse vs Better on MSPB, From FY 2014 to FY 2015

MSPB indicates Medicare spending per beneficiary; SNF, skilled nursing facilities. Worse on MSPB indicates that a hospital went from low cost to middle or high cost, or from middle cost to high cost. better on MSPB, a hospital went from middle or high cost to low cost, or from high cost to middle cost. P values are from t tests comparing the differences in changes in spending between hospitals that got better or worse.

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