Methodological Approaches to Examining Home Health Using Traditional Medicare and Medicare Advantage Claim Data
本文描述了一种基于索赔数据构建家庭健康住院的新方法，并比较了传统医疗保险和医疗保险优势计划在2019年和2021年的使用情况，发现方法在PDGM实施前后均可行。
OBJECTIVE: To describe a claims-based methodology for constructing new home health stays using traditional Medicare (TM) claims data and Medicare advantage (MA) encounter data. STUDY SETTING AND DESIGN: To demonstrate our methodology's performance, we assessed the percentages of TM and MA beneficiaries with one and two or more stays, and the mean length of a stay (LOS) among home health recipients. We compared 2019 and 2021 results to evaluate the methodology's feasibility pre- and post-implementation of the Patient-Driven Groupings Model (PDGM). DATA SOURCES AND ANALYTIC SAMPLE: We used 2019 and 2021 TM and MA home health claims and 2019 outcome and assessment information set for a nationally representative 20% sample of Medicare beneficiaries. PRINCIPAL FINDINGS: In 2019, a lower percentage of MA beneficiaries had new home health stays than TM (5.9% vs. 6.5%). Among home health recipients, approximately 90% had a single stay. The mean LOS in MA was 39 days, compared with 44 days in TM. The statistics from the 2021 data were similar, except that the mean LOS in TM increased to 46 days. CONCLUSIONS: Our claims-based new home health stay methodology is feasible both pre- and post-PDGM and would enable direct comparisons of home health utilization in TM and MA.