Additional Research on Post-Acute Care Episode Based Risk Adjustment

This task order will expand upon ASPE's current work episode-based risk adjustment analysis with RTI under (HHSP23320095651WC_HHSP23337014T). The current episode-based risk adjustment models use Continuity Assessment Record and Evaluation (CARE) Tool assessment data or the current Medicare assessment tool data required by home health agencies (HHA), skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) and claim-based approaches for Medicare long-term care hospitals (LTCHs).

The contractor shall expand the current episode definitions used in the episode-based risk adjustment models to include additional Medicare services beyond PAC in each episode definition (i.e., inclusion of physician and non-physician practitioner services, other Medicare services). The contractor shall update the current episode-based risk adjustment models by using the most recent available patient assessment data from the outcome assessment information set (OASIS) used in HHAs, minimum data set (MDS) used in SNF, and inpatient rehabilitation facility patient assessment information (IRF-PAI) used in IRFs. Medicare payments to LTCHs use a re-weighted Medicare-Severity Adjusted Diagnostic-Related Group (MS-DRG) to case mix adjust payments, not an assessment based case-mix adjustment.

This project will take a iterative approach to exploring the impact of the updated episode-based risk adjustment models in their ability to predict episode costs associated with acute hospital initiated episodes both including and excluding the prior hospital stay (i.e., (1) including the acute hospital stay, PAC, and other Medicare services in the post-discharge period and (2) PAC and other Medicare services in the post discharge period following acute hospital discharge). The approach will start by: (1) examining the impact of using the MS-DRG in the model to assess whether it is appropriate and increases the explanatory power for an acute initiated episode including the acute hospital stay, (2) adding co-morbidities, (3) comparing the Continuity Assessment Record and Evaluation (CARE)-based models developed in the first prong of this project. Our current models focus on the power in explaining costs and payments in the PAC service episode following the index acute hospital stay event, not the inclusion of the hospital stay in the predictive modeling. The optional service tasks will also build on modeling recommendations provided by an external technical expert panel funded under the current contract. This project includes a base period and optional service tasks.