Changes in the use of postacute care during the initial Medicare payment reforms.
Changes in the use of postacute care during the initial Medicare payment reforms.
复制标题
最初的医疗保险支付改革期间急性后期护理的使用发生了变化。
DOI：
10.1111/j.1475-6773.2006.00546.x
复制
发表时间：
2006
影响因子：
3.4
通讯作者：
Petroski,GregoryF
中科院分区：
文献类型：
--
作者：
Lin,Wen-Chieh;Kane,RobertL;Mehr,DavidR;Madsen,RichardW;Petroski,GregoryF
目的：研究在1997年平衡预算法案实施的最初医疗保险支付改革期间，急性期后护理（PAC）使用的变化。数据来源：我们使用了1996年、1998年和2000年5%医疗保险受益人样本的索赔数据。Denominator文件、Provider of Service文件和Area Resource文件中的链接数据提供了额外的患者、医院和市场区域特征。研究设计：选择PAC使用率高的6个疾病组进行分析。我们使用多项logit回归来检查PAC的使用如何因服务年限而异，控制患者，医院和市场区域特征。主要发现：PAC的使用发生了重大变化，部分服务转向了报销仍然基于成本的设置。在第一次改革期间，家庭卫生机构临时支付系统，家庭卫生使用在疾病组中持续下降。这一下降伴随着熟练护理设施（SNF）的使用增加。SNFs的前瞻性支付系统的实施后，使用住院康复facilities increased.Conclusions.在使用设置之间的转变发生在两个阶段，对应于支付改革的时间为家庭卫生机构和SNFs。证据强烈表明PAC设置之间的可替代性。除了临床需求和个人偏好外，经济激励在PAC的使用中发挥着重要作用。
Objective.To examine changes in postacute care (PAC) use during the initial Medicare payment reforms enacted by the Balanced Budget Act of 1997.Data Sources.We used claims data from the 5 percent Medicare beneficiary sample in 1996, 1998, and 2000. Linked data from the Denominator file, Provider of Service file, and Area Resource File provided additional patient, hospital, and market‐area characteristics.Study Design.Six disease groups with high PAC use were selected for analysis. We used multinomial logit regression to examine how PAC use differed by year of service, controlling for patient, hospital, and market‐area characteristics.Principal Findings.There were major changes in PAC use, and a portion of services shifted to settings where reimbursement remained cost‐based. During the first reform, the home health agency interim payment system, home health use decreased consistently across disease groups. This decrease was accompanied by increased use in skilled nursing facilities (SNFs). Following the implementation of the prospective payment system for SNFs, the use of inpatient rehabilitation facilities increased.Conclusions.The shift in usage among settings occurred in two stages that corresponded to the timing of payment reforms for home health agencies and SNFs. Evidence strongly suggests the substitutability between PAC settings. Financial incentives, in addition to clinical needs and individual preferences, play a major role in PAC use.