The Effects of Medicare’s “Medical Review” program on Inpatient Hospitalization, Patient Outcomes, and Costs of Care

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Title
The Effects of Medicare’s “Medical Review” program on Inpatient Hospitalization, Patient Outcomes, and Costs of Care
Contributors
Silver, Benjamin Chase (creator)
Mor, Vincent (Advisor)
Rahman, Momotazur (Reader)
Gozalo, Pedro (Reader)
Besdine, Richard (Reader)
Wright, Brad (Reader)
Brown University. Department of Health Services, Policy and Practice (sponsor)
Copyright Date
2018
Abstract
Short inpatient hospital stays (i.e., two days or fewer) have long been an area of emphasis for the Centers for Medicare & Medicaid Services (CMS) in their efforts to reduce costs of care. These patients are often far less costly to treat, yet receive the full diagnosis-related group (DRG) reimbursement when admitted as inpatients. In recent years, cost containment efforts by CMS have attempted to incentivize greater use of “observation” as a substitute for inpatient admission for patients with less extensive care needs. It remains unclear, however, whether these efforts have resulted in any adverse health outcomes for patients, and whether they have actually achieved the desired cost savings. The purpose of this work was to examine the effects of one particular CMS cost containment effort, Medical Reviews (MR) conducted by Medicare Administrative Contractors (MAC), on use of inpatient admission for short hospital visits, and the subsequent effects of patient health outcomes and overall costs of care. In Chapter 1, we examine the relationship between implementation of MR and the likelihood of admission to an inpatient stay among patients with one of six primary intake diagnoses of interest. In Chapter 2, we exploit a relationship observed in Chapter 1 among patients presenting with “Non-Specific Chest Pain” in an instrumental variables approach to estimate the local average treatment effect on return to the hospital and mortality within 30 days and 90 days of discharge. Finally, in Chapter 3, we again exploit this instrument to estimate the effect on the patient’s total costs of care, including expenditures after discharge from the hospital. We find a significant relationship between introduction of MR and inpatient admission rates among patients with “Non-Specific Chest Pain.” However, we find no subsequent effect on return to the hospital or mortality at 30 or 90 days, and a significant reduction in total costs of care associated with treatment under observation. Overall, our findings suggest that among patients presenting in the ED with “Non-Specific Chest Pain” affected by this policy change, the MR program successfully reduced costs without compromising patient outcomes.
Keywords
Medical policy
Medicare
Hospitals
Hospitals--Observation units
Notes
Thesis (Ph. D.)--Brown University, 2018
Extent
IX, 67 p.

Citation

Silver, Benjamin Chase, "The Effects of Medicare’s “Medical Review” program on Inpatient Hospitalization, Patient Outcomes, and Costs of Care" (2018). Health Services, Policy & Practice Theses and Dissertations. Brown Digital Repository. Brown University Library. https://repository.library.brown.edu/studio/item/bdr:792620/

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