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.

项目摘要 急性期后护理（PAC）越来越普遍，费用也越来越高。五分之一的医疗保险受益人接受护理 在一家专业护理机构住院治疗后，每年的费用超过280亿美元。不幸的是， 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。技术护理设施价值采购计划（SNF VBP） 将医疗保险报销与SNF的30天全因医院再入院率联系起来。确定 SNF VBP对患者结局的影响对患者、卫生系统和政策制定者至关重要， 为其他急性期后护理环境中类似方案的制定和实施提供信息。评价 这一政策的潜在意外后果尤其重要，因为SNF面临着重大的 财务压力，以及照顾大部分特别容易受到疾病影响的患者的SNF。 不良结局（例如，虚弱、认知受损、贫穷或种族和少数民族人群）是最常见的 根据该计划，可能会受到惩罚，可能会导致差距扩大。COVID-19疫情 可能放大了SNF VBP的影响，对已经受到SNF压力的SNF来说， 越南船民迫切需要确定SNF VBP对患者结局和差异的影响， 特别是考虑到COVID-19的放大效应。我们的长期目标是推动交付高价值的 照顾所有离开医院的老年人。SNF VBP是第一个按绩效付费的项目之一， 急性护理环境。为了促进这些政策的发展和成功， 了解它们的设计和实施如何影响结果。我们的核心假设，基于 初步数据显示，SNF VBP在已经表现出色的SNF中达到了预期效果，但 对低性能SNF有意想不到的负面影响。我们的具体目标是：1）确定 在COVID-19大流行之前，SNF VBP对预期结果的影响; 2）确定SNF的影响 （3）确定国家家庭基金对越南船民的经济处罚 受影响的COVID-19准备和结果;以及4）评估组织背景的关键方面， 改善SNF VBP表现的SNF，并探讨这如何影响其对COVID-19的应对。 实现这些目标将改善未来越南船民措施的设计，并为他们提供更高价值的照顾。 越来越多的弱势老年人接受SNF护理。