title: Medicare post-acute care episodes and payment bundling.
abstract: BACKGROUND
  The purpose of this paper is to examine service use in an episode of acute and post-acute care (PAC) under alternative episode definitions and to look at geographic differences in episode payments.
  
  
  METHODS
  The data source for these analyses was a Medicare claims file for 30 percent of beneficiaries with an acute hospital initiated episode in 2008 (N = 1,705,794, of which 38.7 percent went on to use PAC). Fixed length episodes of 30, 60, and 90 days were examined. Analyses examined differences in definitions allowing any claim within the fixed length period to be part of the episode versus prorating a claim extending past the episode endpoint. Readmissions were also examined as an episode endpoint. Payments were standardized to allow for comparison of episode payments per acute hospital discharge or PAC user across states.
  
  
  RESULTS
  The results of these analyses provide information on the composition of service use under different episode definitions and highlight considerations for providers and payers testing different alternatives for bundled payment.
authors.affiliation: RTI International.
authors.forename: Melissa
authors.initials: M
authors.lastname: Morley
authors.affiliation: Department of Health and Human Services-Office of the Assistant Secretary for Planning and Evaluation.
authors.forename: Susan
authors.initials: S
authors.lastname: Bogasky
authors.affiliation: The Brookings Institution-Engelberg Center for Health Care Reform.
authors.forename: Barbara
authors.initials: B
authors.lastname: Gage
authors.affiliation: Centers for Medicare & Medicaid Services-Center for Medicare & Medicaid Innovation.
authors.forename: Shannon
authors.initials: S
authors.lastname: Flood
authors.affiliation: RTI International.
authors.forename: Melvin J
authors.initials: MJ
authors.lastname: Ingber
mesh_terms: D003422:Critical Care / Q000191:economics*; D017050:Episode of Care; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D006278:Medicare / Q000191:economics*; D014481:United States
keywords: DRGs; FFS; Medicare; RBRVS; access; capitation; demand; health care costs; payment systems; rehabilitation services; risk adjusted payments; utilization of services