Association Between Increased Hospital Reimbursement for Cardiac Rehabilitation and Utilization of Cardiac Rehabilitation by Medicare Beneficiaries: An Interrupted Time Series.
Association Between Increased Hospital Reimbursement for Cardiac Rehabilitation and Utilization of Cardiac Rehabilitation by Medicare Beneficiaries: An Interrupted Time Series.
复制标题
医疗保险受益人心脏康复的医院报销增加与心脏康复的利用之间的关联：一个中断的时间序列。
DOI：
10.1161/circoutcomes.120.006572
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Peterson PN
中科院分区：
文献类型：
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作者：
Fletcher DR;Grunwald GK;Battaglia C;Ho PM;Lindrooth RC;Peterson PN
尽管心脏康复 (CR) 是 I 类指南建议，被证明是心脏事件后一种具有成本效益的干预措施，但其报销水平不足以支付医院运营费用。 2011 年 1 月，Medicare 将医院门诊 CR 的支付费用增加了约 180%。我们评估了这种付款增加与符合条件的 Medicare 受益人参与 CR 之间的关联，以更好地了解报销政策与 CR 利用之间的关系。我们从 5% 的 Medicare 索赔样本中，确定了 2009 年 1 月 1 日至 2012 年 9 月 30 日期间患有急性心肌梗死、冠状动脉搭桥手术、经皮冠状动脉介入治疗或心脏瓣膜手术的患者，在事件发生后 30 天仍存活，并连续参加 Medicare 按服务收费 A/B 部分四个月。 CR 参与的趋势和变化是使用中断时间序列方法和分层逻辑模型、医院随机截取来估计的，并根据患者、医院、市场和季节性因素进行调整。估计值是使用百分比规模的平均边际效应来表达的。在 76,695 名符合条件的患者中，平均每年 CR 参与率为 19.5%。在付款增加之前的时期，调整后的年度参与度增长了 1.1 个百分点（95% 置信区间 (CI)：0.48、2.4）。新付款方式实施后，CR 参与度并未立即发生变化。在费用增加后的时期，平均每年有20%的患者参加CR。与前期相比，后期 CR 参与度年增长率放缓 1.3 个百分点（95% CI：-2.4，-0.12）。结果对时间窗口变化有些敏感。 2011 年 CR 医疗保险报销的增加与参与率的增加无关。未来的研究应该评估支付是否未达到激励医院的门槛，或者医院是否对报销变化不敏感。
Although cardiac rehabilitation (CR) is a Class I Guideline recommendation, shown to be a cost-effective intervention following a cardiac event, it has been reimbursed at levels insufficient to cover hospital operating costs. In January 2011, Medicare increased payment for CR in hospital outpatient settings by approximately 180%. We evaluated the association between this payment increase and participation in CR of eligible Medicare beneficiaries to better understand the relationship between reimbursement policy and CR utilization. From a 5% Medicare claims sample, we identified patients with acute myocardial infarction, coronary artery bypass surgery, percutaneous coronary intervention, or cardiac valve surgery between January 1, 2009 and September 30, 2012, alive 30 days after their event, with continuous enrollment in Medicare fee-for-service, Part A/B for four months. Trends and changes in CR participation were estimated using an interrupted time series approach with a hierarchical logistic model, hospital random intercepts, adjusted for patient, hospital, market, and seasonality factors. Estimates were expressed using average marginal effects on a percent scale. Among 76,695 eligible patients, average annual CR participation was 19.5% overall. In the period prior to payment increase, adjusted annual participation grew by 1.1 percentage points (95% Confidence Interval (CI): 0.48, 2.4). No immediate change occurred in CR participation when the new payment was implemented. In the period after payment increase, on average 20% of patients participated in CR annually. The annual growth rate in CR participation slowed in the post-period by 1.3 percentage points (95% CI: −2.4, −0.12) compared to the prior period. Results were somewhat sensitive to time window variations. The 2011 increase in Medicare reimbursement for CR was not associated with an increase in participation. Future studies should evaluate whether payment did not reach a threshold to incentivize hospitals or if hospitals were not sensitive to reimbursement changes.