Effect of post-acute care pay for performance in skilled nursing facilities on outcomes and disparities

熟练护理机构的急性后护理薪酬对结果和差异的影响

• 批准号: 10365771
• 负责人: Robert Edward Burke
• 金额: $ 33.01万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10365771
• 关键词: COVID-19; COVID-19 impact; COVID-19 pandemic; COVID-19 pandemic effects; Caring; Data; Development; Elderly; Elements; Face; Fee-for-Service Plans; Future; Goals; Health; Health care facility; Health system; Home; Hospitalization; Hospitals; Impaired cognition; Incentives; Individual; Interview; Lead; Length of Stay; Medicare; Methods; Outcome; Patient-Focused Outcomes; Patients; Performance; Policies; Prevalence; Process; Readiness; Schedule; Shapes; Skilled Nursing Facilities; Stress; Structure; Testing; Time; Vulnerable Populations; acute care; adverse outcome; base; beneficiary; care outcomes; coronavirus disease; cost; design; ethnic minority; ethnic minority population; evidence base; hospital readmission; improved; improved outcome; insight; low socioeconomic status; mortality; patient population; payment; personal protective equipment; pressure; programs; public health relevance; racial and ethnic; racial minority; readmission rates; response; stressor; success

Project summary Post-acute care (PAC) is increasingly common and costly. One in five Medicare beneficiaries receives care after hospitalization in a skilled nursing facility at a cost of more than $28 billion annually. Unfortunately, more than 1 in 4 Medicare beneficiaries are readmitted to the hospital within 30 days, and these readmissions are associated with increased mortality. The Skilled Nursing Facility Value-Based Purchasing program (SNF VBP) ties Medicare reimbursements to SNF to their 30-day all-cause hospital readmission rates. Determining the effect of SNF VBP on patient outcomes is crucial for patients, health systems, and policymakers, and will inform the development and implementation of similar programs in other post-acute care settings. Evaluating potential unintended consequences of this policy is especially important because SNFs face significant financial pressure, and SNFs that care for large proportions of patients who are especially vulnerable to adverse outcomes (e.g. frail, cognitively impaired, poor, or racial and ethnic minority populations) are most likely to be penalized under the program, potentially leading to increased disparities. The COVID-19 pandemic may have magnified the effects of SNF VBP, acting as a second “stress” on SNFs already stressed by SNF VBP. There is an urgent need to determine the effect of SNF VBP on patient outcomes and on disparities, especially given the magnifying effect of COVID-19. Our long-term goal is to drive the delivery of high-value care for all older adults leaving the hospital. SNF VBP is among the first pay-for-performance programs in post- acute care settings. In order to improve the development and success of these policies, it is crucial to understand how their design and implementation influences outcomes. Our central hypothesis, based on preliminary data, is that SNF VBP achieves its intended effects at SNFs that were already high-performing, but has unintended and negative effects at low-performing SNFs. Our specific aims are to: 1) Determine the impact of SNF VBP on intended outcomes prior to the COVID-19 pandemic; 2) Determine the effect of SNF VBP on disparities in outcomes in vulnerable populations; 3) Determine how financial penalties from SNF VBP impacted COVID-19 readiness and outcomes; and 4) Assess key aspects of organizational context among SNFs that improved performance in SNF VBP and explore how this impacted their response to COVID-19. Accomplishing these aims will improve the design of future VBP initiatives, and lead to higher-value care for the growing number of vulnerable older adults receiving SNF care.

项目概要 急性期后护理 (PAC) 越来越普遍且昂贵。五分之一的医疗保险受益人接受护理 在专业护理机构住院治疗后，每年花费超过 280 亿美元。不幸的是，更多 超过四分之一的医疗保险受益人在 30 天内重新入院，这些重新入院是 与死亡率增加有关。熟练护理设施基于价值的采购计划 (SNF VBP) 将 SNF 的 Medicare 报销与其 30 天全因住院率联系起来。确定 SNF VBP 对患者结果的影响对于患者、卫生系统和政策制定者至关重要，并且将 为其他急性后护理环境中类似计划的制定和实施提供信息。评估中 这项政策潜在的意外后果尤为重要，因为 SNF 面临着重大风险 财务压力，以及照顾大部分特别容易受到影响的患者的 SNF 不良后果（例如体弱、认知障碍、贫穷或种族和族裔人口）是最常见的 可能会受到该计划的处罚，从而可能导致差距扩大。 COVID-19 大流行 可能放大了 SNF VBP 的影响，对已经受到 SNF 压力的 SNF 充当第二个“压力” VBP。迫切需要确定 SNF VBP 对患者结果和差异的影响， 特别是考虑到 COVID-19 的放大效应。我们的长期目标是推动高价值的交付 照顾所有离开医院的老年人。 SNF VBP 是后勤保障体系中首批按绩效付费的计划之一。 急性护理环境。为了促进这些政策的制定和成功，至关重要的是 了解其设计和实施如何影响结果。我们的中心假设基于 初步数据显示，SNF VBP 在已经高性能的 SNF 上实现了预期效果，但是 对性能低下的 SNF 会产生意想不到的负面影响。我们的具体目标是： 1) 确定 SNF VBP 对 COVID-19 大流行之前的预期结果的影响； 2) 确定SNF的效果 关于弱势群体结果差异的 VBP； 3) 确定 SNF VBP 如何进行经济处罚 影响了 COVID-19 的准备情况和结果； 4) 评估组织环境的关键方面 SNF 提高了 SNF VBP 的性能，并探讨了这如何影响他们对 COVID-19 的响应。 实现这些目标将改进未来 VBP 计划的设计，并为患者带来更高价值的护理 接受 SNF 护理的弱势老年人数量不断增加。