The Geography of Medicare Beneficiary Hospitalizations 2012 Data

Transcription

1 The Geography of Medicare Beneficiary Hospitalizations 2012 Data Gary, PhD Mandi-Leigh Peterson, MA Alana Knudson, PhD Rural Health Reform Policy and Research Center Center for Rural Health/NORC University of North Dakota Applied Geography Conference, Louisville, Kentucky: October 27, 2016 The Geography of Medicare Beneficiary Hospitalizations Funding: Federal Office of Rural Health Policy Health Resources and Services Administration 1

2 Study Aims (Rural Emphasis) 1. Describe where rural Medicare beneficiaries are hospitalized by residence, hospital location et al. 2. Perform hospital analyses per RUCAs and FARs 3. Describe hospital bypassing, especially CAHs 4. Perform travel time sensitivity analyses of bypassing 5. Determine associations of available factors related to hospital use and location 6. Determine differences in geographic and hospital type use by diagnosis, surgery, procedure, age, sex, etc. 7. Examine discharge to other hospital for rural residents 8. Document travel times and access deserts MEDPAR Data MEDPAR data (aka: Medicare Part A) 2. Limited to 50 states and DC 3. Includes only hospitalizations for beneficiaries 65 & + 4. Number of hospitalizations: 11,043, Number of hospitalized beneficiaries: 6,941, Examples of file variables: 1. Demographics (e.g., age, sex, and education) 2. Location (e.g., ZIP, county, and state) 3. Medical condition/care (e.g., diagnoses, procedures) 4. Hospital stay (e.g., source, disposition, LOS, charges) 5. Medicare/Medicaid status and other data items 2

3 Data Links With MEDPAR Data 1. Rural- Commuting Area (RUCA) codes (cats: isolated small rural, small rural, large rural, & urban) 2. Frontier and Remote (FAR) codes 3. Calculated paved road travel times and miles 4. ZIP code population 65 and older 5. ZIP/county ecological data (e.g., poverty) 6. Hospital types (e.g., CAH, SCH, for-profit status) 7. Calculated (e.g., unique beneficiaries, # of hospitalizations, and geographic patterns of multiple hospitalizations (geographic patterns)) 8. Other 3

4 Chartbook Limitations #1 v Preliminary v Provisionary v Conditional v Interim v Qualified v Crude v Temporary 4

5 Limitations #2 v Travel times are not exact v Do not know if travel from home v Do not know emergent nature of admit v Do not know patient prognosis et al. v Inaptitude of investigators v Differences in social norms v and more Percentage Hospitalized Beneficiaries and Population by RUCA Categories % U.S Hospitalized Beneficiaries % U.S. Population 65 and older Percent Bypass 008a.dg7 5

6 Medicare Beneficiaries Hospitalizations by Residence (& Population) Age 65 and Older (2012) 0 Isolate Bypass 150b.dg Total Unique Patients Total Visits Total Inpatient Days U.S. Population (65 and Older) Unique Beneficiaries Age & Sex by Residence RUCA Location Type Percent/Median Age and Sex Bypass 040a.dg7 > 75 Years Old > 90 Years Old Mean Age Median Age % Female Medicare Beneficiary Geographic RUCA Residence Type 6

7 Beneficiary Hospital Admits by Census Division and RUCA Category New England Middle Atlantic East North Central West North Central South Atlantic East South Central West South Central Mountain Pacific File: Bypass 015a.dg Percent of Hospital Visits by Benificiary Residence Type Hospital Admissions by Elderly Medicare Beneficiary Residence Location 2012 Patient Residence Location Type ZIP code locations by Rural- Commuting Areas (RUCAs), Version % 0% 0% 1% 99% 2% 14% Hospital Destination Type: 42% 34% 45% 1% 2% 63% 22% 19% File: Bypass 001d.dg7 Total Medicare beneficiary visits by residence location: 9,903,864 (89.9%) 707,512 ( 6.4%) 301,669 ( 2.7%) 8,441 ( 1.0%) 14% 7

8 Hospital Admissions by Elderly Medicare Beneficiary Residence Location 2012 ZIP code locations by Rural- Commuting Areas (RUCAs), Version 3.1 Patient Residence Location Type 0.1% 0.4% 0.9% 98.6% 42.7% 1.8% 13.8% 41.7% Hospital Destination Type: 34.1% 0.8% 2.5% 62.6% 44.8% 19.4% 22.3% 13.5% File: Bypass 002a.dg7 Total Medicare beneficiary visits by residence location: 9,903,864 (89.9%) 707,512 ( 6.4%) 301,669 ( 2.7%) 8,441 ( 1.0%) Hospital Bypassing 1) Bypassing is a rural phenomena and an urban phenomena 2) Obtaining care from a hospital that is not the closest (travel time and/or travel miles) 3) For example: Not going to CAH minutes away and going to a non CAH rural hospital instead 4) Complex decisions on hospital choice research literature not nearly definitive 8

9 Beneficiary Residence Location (RUCA) Closest Hospital CAH Non CAH Rural Non CAH Percent of Geographic Category Bypass 005a.dg7 Closest CAH Bypass Behavior Sensitivity Analysis by Residence Location (698,562 Hospital Stays For Benes Type Where CAH Was Closest Hospital) CAH CAH + <15 Minutes CAH + <30 minutes CAH + <45 Minutes Means 67.0% of benes bypass closest CAH (33.0% used closest) % Hospital Visits Where Closest CAH is Bypassed (Only 1.8% closest to CAH.) Medicare Beneficiary Geographic Residence Type File: Bypass 007a:dg7 9

10 60 CAH Hospital Bypass Behavior Sensitivity Analysis: Destination of Where Closest Benes Bypassed (289,973 Bypass Hospitalizations -- Within 15 Minute Criteria Used ) % Hospital Visits by Bene Residence Type & Bypassing Destination Type File: Bypass 207a:dg (Only 1.8% closest to CAH.) Medicare Beneficiary Geographic Residence Type Other CAH Other Rural Non CAH % CAH Bypass* by State** (Visits) AL 72.4 GA 68.3 MI MS NM WV VA CA OR KY States (Sorted by Bypass % High to Low) TX WY WA NY OK MO AR WS MN ND NC IN MT ID CO SD PA IL IA NE KS ME OH NH * Bypass is adjusted for alternative hospitals within 15 minutes travel of the index closest travel time CAH. ** States are not included because they had fewer than 00 relevant hospitalizations and/or they had no relevant CAHs. VT 34.3 Bypass 0a.dg Percent Rural Hospital Bypass

11 % CAH Bypass* by State** (Visits) TN 73.0 AZ 69.4 FL OK NM WV LA MO AR MS GA States (Sorted by Bypass % High to Low) WA NY KY NC VA MI OH TX IN IL WS CA ND OR MN IA CO ID WY * Bypass is adjusted for alternative hospitals within 15 minutes travel of the index closest travel time CAH. SD NE KS VT MT ** States are not included because they had fewer than 00 relevant hospitalizations and/or they had no relevant CAHs. NH 37.2 ME 36.7 Bypass 1a.dg Percent Rural Hospital Bypass % CAH Bypass* by State** (Visits) AZ 74.3 VA NC TN 58.8 MO 58.5 MI 58.0 NM 55.7 OK 55.3 CO 55.2 States (Sorted by Bypass % High to Low) IN GA WA MS LA TX OR OH ME WS MN SD KS CA ND KY NE * Bypass is adjusted for alternative hospitals within 15 minutes travel of the index closest travel time CAH. AR IA IL ID FL ** States are not included because they had fewer than 00 relevant hospitalizations and/or they had no relevant CAHs. NH 23.0 Bypass 2a.dg Percent Rural Hospital Bypass 11

12 Closest Rural Non CAH (RNC) Hospital Bypass Behavior Sensitivity Analysis by Residence Location Type (1,047,957 Hospital Stays For Benes Where RNC Was Closest Hospital) Other RNC NRC + <15 Minutes RNC + <30 minutes RNC + <45 Minutes 72.3 % Hospital Visits Where Closest RNC Is Bypassed Means 53.7% of benes bypass closest RNC (46.6% used closest) (Only 1.2% closest to RNC.) Medicare Beneficiary Geographic Residence Type File: Bypass 7a:dg7 Medicare Beneficiary Hospitalizations by Residence Type (RUCA Versus FAR) Geographic RUCA Rural Categories: Isolate % of hospitalizations by Large Rural beneficiaries are also designated as Frontier per FAR Level 1. Percent Frontier Bypass 090a.dg7 2.2 Level 1 Level 4 Frontier and Remote (FAR) Codes (Level 1 and Level 4)

13 % Bypass Sensitivity to Closest Criteria by Frontier Location (FAR) 70 Level 1 Level 2 Level 3 Level Percent Bypass Bypass 170a.dg7 Closest Closest & < 15 Minutes Closest & < 30 Minutes Closest & < 45 Minutes Bypass Criteria Beneficiary Hospitalization Source by Hospital RUCA Location (Visits) 70.7 Physician Referral Clinic Referral Trans Other Hosp Trans Same Hosp Trans Other HC Fac Hospital RUCA Location Category: 1.6 Trans SNF Other File: Bypass 030a.dg Percent of Hospital Visits by Benificiary Hospital Location Type 13

14 Beneficiary CAH Hospitalization Source by Hospital RUCA Location (Visits) Physician Referral Clinic Referral Trans Other Hosp Trans Same Hosp Trans Other HC Fac Hospital RUCA Location Category: 1.4 Trans SNF Other File: Bypass 031a.dg Percent of Hospital Visits by Benificiary Hospital Location Type Beneficiary Hospital Discharge Destination by Hospital RUCA Location (Visits) Routine Short-Term Hosp Skilled Nursing Fac Home Health Svcs Intermediate Care Hospice Home/Fac Inpatient Rehab Long Term Care Expired Other Hospitalization Location RUCA Type: File: Bypass 020a.dg Percent of Hospital Visits by Benificiary Residence Type 14

15 Beneficiary CAH Hospital Discharge Destination by Hospital RUCA Location (Visits) Routine Short-Term Hosp Skilled Nursing Fac Home Health Svcs Intermediate Care Hospice Home/Fac Inpatient Rehab Long Term Care Expired Other Hospitalization Location RUCA Type: File: Bypass 021a.dg Percent of Hospital Visits by Hospital RUCA Location Type Major Diagnostic Categories Frequency Ranks All Hospitals CAHs Only Non Rural CAH 1) Circulatory System 2 1 2) Respiratory System 1 2 3) Musculoskeletal System & Conn Tissue 5 3 4) Digestive System 4 4 5) Nervous System 7 5 6) Kidney & Urinary Tract 6 6 7) Infect Parasitic Diseases 7 8) Rehabilitation, Aftercare et al ) Endocrine, Nutritional/Metabolic 8 8 ) Hepatobiliary System & Pancreas 11 11) Skin, Subcutaneous Tissue & Breast

16 Next? v Age & Sex v Diagnosis & Procedures v State & Regional Analyses v? v? v? What Next? Chartbook State Analyses Associations Bypass Detail Travel Times DRGs MDCs Transfers Diagnoses State Analyses Non CAH Bypass Snowbirds Determine ZIP Centroid Time Error Role of Rural Non CAH Hosp Age, Sex & Poverty Mayo/Cleveland Clinic Trips Geographic Travel Patterns Rural bene hospital access deserts Journal Paper(s) $$ Charges $$ Etc. Etc. Etc. 16

17 Gary, PhD 17