CMS Medicare Spending per Beneficiary Analytics and Monitoring by Dexur
How Dexur Helps in Improving MSPB Average?
Dexur analyzes Medicare Claims data to evaluate MSPB cost per episode for hospitals. MSPB Hospital measure assesses the cost to Medicare for services performed by hospitals and other healthcare providers during an episode of care (episode), which is composed of the periods immediately prior to, during, and following a patient’s hospital stay. CMS stresses the importance of measuring the cost of care explicitly to recognize hospitals that are involved in the provision of high-quality care at a lower cost, in conjunction with other quality measures. Dexur also calculates and tracks all measures that impact different CMS programs.
Dexur also calculates and tracks all CMS measures including Readmission rates which is a major factor in driving the MSPB episode costs. Dexur’s research based on Real World Evidence (RWE) provides insights on Hospital Specific Micro Cohorts which have a higher risk for readmission and are significant contributors to overall increase in Hospital MSPB cost.
Challenges with Monitoring CMS Programs
How Dexur Helps Hospitals with CMS Measures
Retroactive CMS VBP measure scores and points hold-up payment adjustments by years
Delay
Dexur data is more recent (5-6 months time lag) and updated every quarter for quicker evaluation
Replicating CMS algorithms to generate data for latest adjustment projections is complex and requires advanced technical insight
Algorithms
Dexur replicates CMS algorithms based on CMS Medicare claims data to monitor quality measures
Hospitals might lack essential data, like patients’ journey post-discharge, to reconcile CMS methods
Data
Dexur tracks a patient journey longitudinally and has access to the in hospital and post discharge utilization and costs
CMS releases stacked up information, which makes analysis of factors affecting the scores and payment uncertain
No Detail
Dexur can do a deep dive on the specific diseases / DRGs that are driving these outcomes
CMS provides MSPB scores that evaluate hospitals’ costs compared to the national median (or midpoint) hospital costs. Dexur calculates average spending levels during hospitals’ MSPB episodes by Medicare claim type.
Dexur breaks down the average spending in 3 time periods, which are further broken down into multiple claim types at the DRG level. Dissection of post-discharge costs such as rehospitalization, nursing home, home health, and hospice costs are shown to determine the cost-driving components and improve them to better the MSPB average.
Dexur also provides MSPB averages and trends of peers to compare important components like SNF, Home Health, Hospice discharge rates over the latest time period.
