Category: Uncategorized

Oral Nutrition Supplements’ Impact on Hospital Outcomes in the Context of the Affordable Care Act and New Medicare Reimbursement Policies

Sunday, October 20, 2013

Key Ballroom Foyer (Hilton Baltimore)

Poster Board # P1-29

Health Services, and Policy Research (HSP)

 

Darius Lakdawalla, Ph.D.¹, Julia Thornton Snider, PhD², Daniella J. Perlroth, MD³, Chris LaVallee, MS², Mark Thomas Linthicum, MPP²and Tomas J. Philipson, PhD⁴, (1)University of Southern California, Los Angeles, CA, (2)Precision Health Economics, Los Angeles, CA, (3)Stanford University, Stanford, CA, (4)The Harris School, The University of Chicago, Chicago, IL

 

Purpose: 

To assess the effect of oral nutrition supplements (ONS) on 30-day readmission rates, length of stay (LOS), and episode costs in hospitalized Medicare patients, aged 65 and over, with diagnoses affected by new Medicare reimbursement rules under the Affordable Care Act (ACA): acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia (PNA).

Methods: 

Analyses were conducted using the Premier Perspectives Database over an eleven-year period (2000-2010) on Medicare patients aged 65+ and carrying a diagnosis of AMI, CHF, or PNA. One-to-one matched samples of ONS and non-ONS episodes were created using propensity score matching, producing samples of 20,870, 38,418, and 47,477 AMI, CHF, and PNA episodes, respectively. To eliminate bias from confounding, instrumental variables (IV) regression analysis was performed to quantify the effect of ONS on the probability of 30-day readmission, as well as on LOS and episode cost. For comparison, analyses were also conducted on elderly Medicare patients with any primary diagnosis, with a 1:1 matched sample of 667,684 episodes.

Results: 

Use of ONS decreased the probability of 30-day readmission, LOS, and episode costs among hospitalized aged 65+ Medicare patients. Most notably, ONS use was associated with a statistically significant (p<0.01) reduction in the probability of readmission within 30 days of 12% for AMI episodes and 10.1% for CHF episodes. The effect on LOS and episode cost was greatest for the comparison population (all primary diagnoses), with decreases of 16.0% and 15.8% (p<0.01), respectively.

Table: Percent change in outcome due to oral nutritional supplements
Population	30-Day Readmission Probability	Length of Stay	Episode Cost
65+ Medicare patients with acute myocardial infarction	-12.0%**	-10.9%**	-5.1%*
65+ Medicare patients with congestive heart failure	-10.1%**	-14.2%**	-7.8%**
65+ Medicare patients with pneumonia	-5.2%	-8.5%**	-10.6%**
All 65+ Medicare patients	-8.4%**	-16.0%**	-15.8%**

Note: * indicates significance at the 5% level; ** indicates significance at the 1% level.

Conclusions:

In the aged 65+ Medicare patient population with AMI and CHF, ONS improves 30-day readmission, LOS, and episode cost outcomes.  This also holds true for all aged 65+ Medicare patients.  Among patients with PNA, ONS improves LOS and episode cost outcomes. ONS use in hospitalized Medicare patients aged 65+ may present an inexpensive, evidence-based solution for hospitals seeking to meet the quality targets established by the ACA.

Source: The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care. HCAHPS also known as the CAHPS Hospital Survey, is a survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience.

While many hospitals have collected information on patient satisfaction for their own internal use, until HCAHPS there was no national standard for collecting and publicly reporting information about patient experience of care that allowed valid comparisons to be made across hospitals locally, regionally and nationally.

Three broad goals have shaped the HCAHPS survey:

First, the survey is designed to produce comparable data on the patient’s perspective on care that allows objective and meaningful comparisons between hospitals on domains that are important to consumers. Second, public reporting of the survey results is designed to create incentives for hospitals to improve their quality of care. Third, public reporting will serve to enhance public accountability in healthcareby increasing the transparency of the quality of hospital care provided in return for the public investment. With these goals in mind, the HCAHPS project has taken substantial steps to assure that the survey is credible, useful, and practical. This methodology and the information it generates are available to the public.

HCAHPS Content and Administration

The HCAHPS survey contains 21 patient perspectives on care and patient rating items that encompass nine key topics: (1) communication with doctors, (2) communication with nurses, (3) responsiveness of hospital staff, (4) pain management, (5) communication about medicines, (6) discharge information, (7) cleanliness of the hospital environment, (8) quietness of the hospital environment, and (9) transition of care.

The survey also includes 4screener questions and 7demographic items, which are used for adjusting the mix of patients across hospitals and for analytical purposes. The survey is 32 questions in length. Hospitals must survey patients throughout each month of the year.

BevMD’s Clearfast® can positively impact the following HCAHPS categories:

Doctor Communication
Nurse Communication
Pain Management
Communication About Medicines
Overall Rating of Hospital
Willingness to Recommend Hospital