Potential impact of bundled Medicare payments

捆绑医疗保险付款的潜在影响

• 批准号: 6346727
• 负责人: JOHN D FITZGERALD
• 金额: $ 15.94万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 1987
• 资助国家: 美国
• 起止时间: 1987-07-15 至 2002-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6346727
• 关键词: Medicare /Medicaid; behavioral /social science research tag; clinical research; health care cost /financing; health care facility; health care service utilization; health services research tag; hospital utilization; human data; joint prosthesis; orthopedics

This project seeks to determine the fiscal impact of increased TC utilization after total joint replacement surgery (TJR) on resource consumption as measured by length of stay (LOS) and expenditures. TJR is an expensive, prevalent surgery costing Medicare $7 billion per year for a total of 354,000 procedures. Over the last decade, hospitals have been utilizing transitional care (TC) units for the management of post-acute rehabilitation with increasing frequency. Acute care length of stay (LOS) has dropped while the utilization of TC has increased. The Health Care Financing Administration is considering an acute care and post-acute care bundled payment system. To study the potential fiscal impact of such a policy, this project proposes to examine the association between TC utilization and resource consumption controlling for patient, hospital and physician characteristics. To address the issue of selection bias, several candidate instrumental variables (IV) will be tested. 'vs when successfully identified are useful to approximate random assignment between the comparison groups. The recent Balanced Budget Amendment changes, and changes in TC utilization provides a unique opportunity to study the relationship between TC utilization and resource consumption. Two datasets will be used to refine and subsequently test the main hypothesis. The Medicare Current Beneficiary Dataset, in addition to administrative billing data, has detailed clinical (including function and comorbidity) and social support variables. Although sample size is restricted to 100 elective hip and knee replacements per year, this dataset will be useful in evaluating candidate instrumental variables. Final analyses will be performed using the larger national Medicare billing dataset.

本项目旨在确定全关节置换术（TJR）后增加TC使用对住院时间（LOS）和支出的资源消耗的财政影响。TJR是一种昂贵的，普遍的手术，每年花费医疗保险70亿美元，共354，000例手术。在过去的十年里，医院越来越频繁地利用过渡性护理（TC）单位来管理急性后康复。急性护理住院时间（LOS）下降，而TC的利用率增加。 卫生保健融资管理局正在考虑建立一个急性护理和急性后护理捆绑支付系统。为了研究这种政策的潜在财政影响，本项目建议检查TC利用率和资源消耗控制患者，医院和医生的特点之间的关联。为了解决选择偏倚的问题，将测试几个候选工具变量（IV）。 当成功识别时，“vs”可用于近似比较组之间的随机分配。最近的平衡预算修正案发生了变化，技术合作利用率的变化为研究技术合作利用率与资源消耗之间的关系提供了一个独特的机会。 将使用两个数据集来完善并随后检验主要假设。除了管理账单数据外，Medicare当前受益数据集还具有详细的临床（包括功能和合并症）和社会支持变量。 虽然样本量限制为每年100例择期髋关节和膝关节置换术，但该数据集将有助于评价候选工具变量。 最终分析将使用更大的国家医疗保险账单数据集进行。