As described earlier, oscillations in GENESIS-CBA occur because some providers switch between tier-1 anon-tier-1r-1 status, which resembles the peering disputes between tier-1 providers seen in practice.
"While the regulations do allow the use of non-Tier 1 sites," in limited circumstances, "we would have expected a large system such as PWD (that self-reported the probable existence of 50,000 LSLs) to do their due diligence by … taking all steps necessary to locate additional Tier 1 sites," Daniels, in an email in early May.
Patients with CMS-defined tier comorbid diabetes stayed longer than patients with non-tier diabetes.
Tier diabetes was associated with longer LOS, lower functional status ratings, and reduced odds of discharge home when compared with individuals with no diabetes and non-tier diabetes.
The prevalence of diabetes in the sample was 23.0%, with 18.3% of patients diagnosed with non-tier diabetes and 4.7% with tier-level diabetes.
In each case, the difference among the diabetes groups (no diabetes versus non-tier diabetes versus tier diabetes) was larger in younger subjects and smaller in older subjects.
We hypothesized that individuals with tier 3 comorbid diabetes would have longer lengths of stay, have poorer functional outcomes, and be discharged home less frequently than people with non-tier diabetes or no diabetes.
There were also significant age-by-diabetes group interactions between the non-tier (OR = 0.98, P < 0.01) and no diabetes (OR = 0.98, P < 0.01) groups compared with the tier-level diabetes group for the discharge home versus not home variable.
This work included secondary analyses of 79,526 individuals from 915 rehabilitation facilities in the U.S. Patients were classified into three groups using the Centers for Medicare and Medicaid Services comorbidity structure: individuals without diabetes (77.0%), individuals with non-tier diabetes (18.3%), and individuals with tier diabetes (4.7%).
Three patient groups were created using the following CMS criteria: 1) patients with no diabetes, 2) patients with non-tier diabetes (ICD-9 250.0–250.3), and 3) patients with tier 3 comorbid diabetes (ICD-9 250.4–250.9, 357.2, and 785.4) (4).
Compared with non-adopters, high users of e-prescribing were more likely to prescribe preferred-tier medications (vs. non-preferred tier) when both non-interruptive and interruptive formulary decision support were in place (OR 1.9[955% CI 1.0-3.4], p = 0.04), but no more likely to prescribe preferred-tier when only non-interruptive formulary decision support was in place (p = 0.90).
