Key result
Hospital discharge reports of post-acute care destinations were not substantiated by Medicare claims in 27.9% of cases, with the highest discrepancy rate for home health agencies (29.6%).
Why the study?
Researchers increasingly rely on data from hospital information systems rather than claims, but the current quality and accuracy of hospital reports on post-acute care use are not known.
Observational
Yes
Hospital-reported discharge locations to post-acute care frequently differ from actual Medicare claims, highlighting potential measurement errors in administrative data.
Discharge destination reports may misrepresent actual post-acute care; leaves open validation needs for administrative data in outcomes research.
OBJECTIVES: Administrative records such as Medicare fee-for-service (FFS) claims provide accurate information on services paid for by Medicare. However, the increasing availability of electronic health records means many researchers may be inclined to rely on data coded in hospital information systems rather than claims. The current quality and accuracy of hospital reports on the use of post-acute care (PAC) services are not known. DESIGN: This study examined differences in the PAC use between hospital discharge status recorded on Medicare Provider and Analysis Review inpatient hospital records and claims for PAC services. SETTING: In addition to assessments of the three types of Medicare-reimbursed PAC (home health agency [HHA], skilled nursing facility [SNF], and inpatient rehabilitation facility [IRF]), the analysis also considered home without PAC services as a default discharge location. PARTICIPANTS: The analysis was conducted using data for FFS beneficiaries who participated in the Medicare Current Beneficiary Survey and had one or more inpatient hospitalizations from 2006 to 2011. MEASUREMENTS: This study measured discrepancies between hospital-reported discharges to PAC and PAC use based on Medicare claims. RESULTS: The study found that, on average, 27.9% of hospital reports of discharging to Medicare-covered PAC services were not substantiated by Medicare PAC claims. Among all the discharge pathways, discharging to HHAs had the highest discrepancy rate (29.6%), followed by IRFs (14.7%) and SNFs (13.8%). CONCLUSION: The study results call for cautions about the extent to which the reported discharge locations on hospital claims may differ from actual PAC services used. Assuming that Medicare FFS claims were complete and accurate, researchers using the discharge status reported on Medicare hospital claims should be aware of possible measurement errors when using hospital-reported discharge locations. J Am Geriatr Soc 68:847-851, 2020.
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Zhu et al. (2019) conducted an observational in Inpatient hospitalizations. Hospital discharge status reports vs. Medicare claims for post-acute care services was evaluated on Discrepancies between hospital-reported discharges to PAC and PAC use based on Medicare claims. Hospital discharge reports of post-acute care destinations were not substantiated by Medicare claims in 27.9% of cases, with the highest discrepancy rate for home health agencies (29.6%).
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