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

Download eBook for Free

Full Document

FormatFile SizeNotes
PDF file 0.2 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.

Summary Only

FormatFile SizeNotes
PDF file 0.1 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.

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.

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

This report is part of the RAND Corporation Working paper series. RAND working papers are intended to share researchers' latest findings and to solicit informal peer review. They have been approved for circulation by RAND but may not have been formally edited or peer reviewed.

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.