The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs
The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs
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DOI：
10.1111/1475-6773.13227
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发表时间：
2019-10-27
影响因子：
3.4
通讯作者：
Coe, Norma B.
中科院分区：
文献类型：
--
作者：
Werner, Rachel M.;Konetzka, R. Tamara;Coe, Norma B.
目的探讨医疗保险技术护理设施（SNF）共同支付政策对住院时间、患者预后和成本的影响，该政策在福利期第20天每日共同支付率大幅增加。2012年至2016年的回顾性队列研究，使用医疗保险索赔和SNF评估数据，包括医疗保险按服务收费受益人的SNF入院情况。研究设计我们首先估计在患者受益期的第21天，医疗保险SNF共付额的变化如何影响SNF停留时间的长短。然后，我们使用入院福利日作为工具变量，以估计与共同支付政策相关的SNF停留时间对再入院和医疗保险支付的影响。从2012年到2016年，我们调查了291134名SNF招生。较高的SNF入院受益日与较短的SNF停留时间密切相关。一天短SNF保持与出院30天内重新接纳率较高(1.5,95%置信区间1.4 - -1.6 P <措施),30天内SNF放电(0.9;95%可信区间0.8 - -1.0),降低医疗保险支付总额90天出院后集(396美元,95%可信区间361 - 431,P <措施),但高179美元SNF放电后90天付款(95%可信区间149 - 210,P <措施),抵消较低的支付短指数SNF留下来。结论医疗保险SNF共同支付政策与住院时间缩短和患者预后较差有关，表明共同支付政策对患者预后有意想不到的负面影响。
Objective To investigate the impact of Medicare's skilled nursing facility (SNF) copayment policy, with a large increase in the daily copayment rate on the 20th day of a benefit period, on length of stay, patient outcomes, and costs. Data Sources and Study Setting Retrospective cohort study from 2012 to 2016 using Medicare claims and SNF assessment data, including SNF admissions for Medicare fee-for-service beneficiaries. Study Design We first estimate how changes in Medicare's SNF copayment on the 21st day of a patient's benefit period affect length of SNF stay. We then use benefit day on admission as an instrumental variable to estimate the impact of SNF length of stay related to the copayment policy on readmission and Medicare payment. Principal Findings From 2012 to 2016, we examined 291 134 SNF admissions. Higher benefit day on SNF admission was strongly associated with shorter SNF stays. A 1-day shorter SNF stay was associated with higher readmission rate within 30 days of hospital discharge (1.5 percentage points; 95% CI 1.4-1.6, P < .001) and within 30 days of SNF discharge (0.9 percentage points; 95% CI 0.8-1.0), lower total Medicare payment for the 90-day episode after hospital discharge ($396; 95% CI 361-431, P < .001), but $179 higher payment for the 90 days after SNF discharge (95% CI 149-210, P < .001), offsetting the lower payment for the shorter index SNF stay. Conclusions Medicare's SNF copayment policy is associated with shorter lengths of stay and worse patient outcomes, suggesting the copayment policy has unintended and negative effects on patient outcomes.