Savings and outcomes under Medicare's bundled payments initiative for skilled nursing facilities.
Savings and outcomes under Medicare's bundled payments initiative for skilled nursing facilities.
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DOI：
10.1111/jgs.17409
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发表时间：
2021-12
影响因子：
6.3
通讯作者：
Epstein AM
中科院分区：
文献类型：
--
作者：
Joynt Maddox KE;Barnett ML;Orav EJ;Zheng J;Grabowski DC;Epstein AM
医疗保险的捆绑式支付护理改善（BPCI）模式3是一种自愿替代支付模式，使参与的熟练护理机构（SNF）对90天的护理费用负责。它对医疗保险支出和临床结果的总体影响尚不清楚。使用2012-2017年医疗保险索赔的回顾性队列研究。我们采用中断时间序列设计，比较参与与匹配对照SNF的90天医疗保险支付总额和支付组成部分（初次SNF住院、再入院和门诊/临床医生），病例组合（数量、医疗补助比例、黑人比例、合并症数量）和临床结局（90天再入院、死亡率和在家健康天数以及初始SNF住院时间），总体和虚弱或痴呆的关键亚组，该计划中48种情况中的47种（不包括主要下肢关节置换术）。我们的样本包括1，001名参与者和3，873名匹配的对照SNF。在基线时，BPCI SNF的医疗保险机构支付总额以每季度每发作121美元的速度增加;在干预期间，支付额以每季度每发作-398美元的速度下降。在对照组中，支付在基线期稳定（+17美元/发作/季度），但在干预期间下降至-424美元/发作/季度，斜率变化为-79美元/发作/季度（95%置信区间[CI]-188美元，31美元，p=0.16）。然而，在虚弱患者中，BPCI组的支出下降了620美元/次/季度，而非BPCI组为330美元/次/季度，斜率变化差异为-289美元（95% CI-482，-96美元，p=0.003）。总体或任何临床亚组的病例选择或临床结局的斜率变化均无差异。SNF参与BPCI与每次发作、病例选择或临床结局的总医疗保险支付无总体差异变化相关。探索性分析显示，虚弱患者的医疗保险支付减少，可能需要进一步研究。
Model 3 of Medicare’s Bundled Payments for Care Improvement (BPCI) was a voluntary alternative payment model that held participating skilled nursing facilities (SNFs) accountable for 90-day costs of care. Its overall impact on Medicare spending and clinical outcomes is unknown. Retrospective cohort study using Medicare claims from 2012–2017. We used an interrupted time series design to compare participating versus matched control SNFs on total 90-day Medicare payments and payment components (initial SNF stay, readmissions, and outpatient/clinician), case mix (volume, proportion Medicaid, proportion Black, number of comorbidities), and clinical outcomes (90 day readmission, mortality and healthy days at home, and length of initial SNF stay), overall and among key subgroups with frailty or dementia, for 47 of the 48 conditions in the program (excluding major lower extremity joint replacement). Our sample included 1,001 participating and 3,873 matched control SNFs. At baseline, total Medicare institutional payments were increasing at BPCI SNFs at a rate of $121 per episode per quarter; during the intervention period, payments decreased at a rate of −$398/episode/quarter. Among controls, payments were stable in the baseline period (+$17/episode/quarter) but decreased at −$424/episode/quarter during the intervention period, yielding a nonsignificant difference in slope changes of −$79/episode/quarter (95% confidence interval [CI] −$188, $31, p=0.16). However, among patients with frailty, spending declined by $620/episode/quarter in the BPCI group, compared with $330/episode/quarter in the non-BPCI group, for a difference in slope changes of −$289 (95% CI −$482, −$96, p=0.003). There were no differences in the change in slopes in case selection or clinical outcomes overall or in any clinical subgroup. SNF participation in BPCI was associated with no overall differential change in total Medicare payments per episode, case selection, or clinical outcomes. Exploratory analyses revealed a decrease in Medicare payments in patients with frailty that may warrant further study.
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影响因子：
105.7
作者：
Rolnick, Joshua A.;Liao, Joshua M.;Navathe, Amol S.
通讯作者：
Navathe, Amol S.
DOI：
10.1093/gerona/glx229
发表时间：
2018-07-01
影响因子：
5.1
作者：
Kim, Dae Hyun;Schneeweiss, Sebastian;Avorn, Jerry
通讯作者：
Avorn, Jerry
影响因子：
120.7
作者：
Barnett, Michael L.;Joynt Maddox, Karen E.;Epstein, Arnold M.
通讯作者：
Epstein, Arnold M.
影响因子：
8.3
作者：
Bhatt, Surya P.;Wells, J. Michael;Dransfield, Mark T.
通讯作者：
Dransfield, Mark T.
影响因子：
5.3
作者：
Dundon, John M.;Bosco, Joseph;Iorio, Richard
通讯作者：
Iorio, Richard