Comparison of Medicare Spending and Outcomes for Beneficiaries with Lower Extremity Joint Replacements

by Melinda Beeuwkes Buntin, Partha Deb, Jose J. Escarce, Carrie Hoverman, Susan M. Paddock, Neeraj Sood

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The primary objective of this study is to conduct a set of analyses comparing costs and outcomes of lower extremity joint replacement patients discharged to three different post-acute settings: inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and patient homes. Multivariate techniques are employed in order to adjust these analyses for observable differences in severity of illness across sites of care. In doing so, multinomial models are used that predict which type of institutional post-acute care a beneficiary accesses, and these predictors are described. In addition, instrumental variables (IV) techniques are used that allow for the accounting of unobserved patient selection into IRFs and SNFs in order to learn how patient costs and outcomes are affected by the availability of IRF and SNF care.

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The research described in this report was prepared for the Medicare Payment Advisory Commission and was performed by RAND Health.

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