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Evaluation of the Reliability of Medicare Spending Per Beneficiary for Post-Acute Care
Bowen Garrett1, Carol Carter2, Doug Wissoker3
1Urban Institute, Health Policy Center.
Background:
A measure of episode spending, such as Medicare Spending Per Beneficiary (MSPB) is increasingly used to evaluate provider performance. Yet if the measure is unreliable, as is often true for low-volume providers, it cannot distinguish "good" from "poor" performance.
Objective:
The objective of this study was to evaluate the reliability of a uniformly calculated MSPB measure for post-acute care (PAC) and the tradeoffs involved in setting a minimum case count threshold.
Data:
Medicare claims for 15 million PAC episodes from April 2013 to March 2015.
Research Design:
Given the overlap in patients treated in PAC settings, we developed a uniformly calculated MSPB measure for PAC providers that measures spending during the PAC stay and the following 30 days. We examine variation in the MSPB-PAC measure and characterize the measure's reliability and its relationship to provider case counts.
Results:
Applied to our MSPB-PAC measure, a minimum threshold of 20 Medicare episodes as currently used by the Centers for Medicare & Medicaid Services (CMS) would not establish reasonably reliable measures and could result in drawing unduly erroneous conclusions about provider performance. The measures for home health agencies were considerably less stable and reliable than for institutional PAC providers.
Conclusions:
CMS should consider adopting a more stringent reliability standard for setting minimum case counts for MSPB-PAC and other measures. Its current threshold (R-statistic=0.4) reflects more random variation than differences in actual provider performance. To include as many providers as possible, CMS should consider pooling data over multiple years to avoid drawing incorrect conclusions about low-volume providers.
Insights
The Medicare Spending Per Beneficiary (MSPB) measure for post-acute care (PAC) is unreliable for low-volume providers. A higher case count threshold is needed to accurately assess provider performance and avoid erroneous conclusions.
Area of Science:
- Health Services Research
- Healthcare Policy
- Medicare Quality Measurement
Background:
- Medicare Spending Per Beneficiary (MSPB) is a key metric for evaluating healthcare provider performance.
- The reliability of MSPB measures is often compromised for providers with low patient volumes.
- Unreliable measures hinder the accurate distinction between high and low-performing providers.
Purpose of the Study:
- To assess the reliability of a standardized MSPB measure for post-acute care (PAC) providers.
- To analyze the trade-offs associated with establishing minimum case count thresholds for MSPB measures.
- To inform policy regarding the accurate evaluation of PAC provider performance.
Main Methods:
- Development of a uniformly calculated MSPB measure for PAC episodes, encompassing spending during PAC stays and the subsequent 30 days.
- Analysis of Medicare claims data for 15 million PAC episodes (April 2013 - March 2015).
- Examination of measure variation, reliability, and its correlation with provider case counts.
Main Results:
- The current Centers for Medicare & Medicaid Services (CMS) minimum threshold of 20 episodes is insufficient for reliable MSPB-PAC measures.
- Low-volume providers risk erroneous performance evaluations due to unreliable measures.
- Home health agencies demonstrated lower measure stability and reliability compared to institutional PAC providers.
Conclusions:
- CMS should implement a stricter reliability standard for minimum case counts for MSPB-PAC and similar performance measures.
- The current CMS threshold (R-statistic=0.4) is inadequate, reflecting more random noise than true performance differences.
- Pooling multi-year data is recommended to improve the reliability of measures for low-volume providers and prevent inaccurate conclusions.
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