Post-BBA Changes in Rural Hospital LTC Strategies

BBA 后农村医院长期护理策略的变化

• 批准号: 6436100
• 负责人: MARY L FENNELL
• 金额: $ 47.34万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-08-15 至 2005-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6436100
• 关键词: Medicare /Medicaid; behavioral /social science research tag; clinical research; extended care facility; health care cost /financing; health care policy; health care service availability; health economics; health services research tag; home health care; hospital length of stay; hospital organization /administration; human subject; longitudinal human study; medically underserved population; patient care management; rural area

DESCRIPTION (provided by applicant): The ongoing implementation of the 1997 Balanced Budget Act (BBA) and the 1999 Balanced Budget Refinement Act (BBRA) continues to adversely affect reimbursements to hospitals and post-acute/long-term care providers. Reimbursement incentives in each setting may be having the practical effect of limiting access to care for Medicare patients requiring complex and costly services, thus further fragmenting the fee-for-service (FFS) continuum of care for the most vulnerable Medicare beneficiaries. A fragmented continuum of care is especially problematic in rural areas, where disruptions can leave large gaps in access to care if the strategic options of providers are constrained or inter-provider relationships (e.g., hospital to nursing home) are weak. Although the intended effects of the BBA and BBRA were to control costs, there are a wide range of possible unintended effects on rural hospitals, their hospital-based nursing homes and home health agencies, and the relationship between hospitals and external post-acute and long-term care providers. The unintended effects on rural hospitals may involve their adoption and/or abandonment of integration strategies, which in turn may affect the care of rural Medicare beneficiaries as well as the overall financial performance of rural hospitals. The results of our earlier study of rural hospitals and their post-acute and long-term care strategies offer a unique baseline from which to examine the unintended effects of the BBA and BBRA. We plan to address three specific aims: (1) To assess how the BBA and BBRA have affected the organizational strategies of rural hospitals to either diversify into long-term care or link to external providers of long-term care; (2) To assess the impact of BBA and BBRA-related strategic behavior on the timing and placement of discharges among at-risk Medicare patients treated in rural hospitals; and (3) To assess the impact of BBA and BBRA-related strategy changes on the financial performance of rural hospitals.

说明(申请人提供)：1997年持续实施情况 《平衡预算法》(BBA)和《1999年平衡预算改进法》(BBRA) 继续对医院的补偿产生不利影响， 急症后/长期护理提供者。每种设置中的报销奖励 可能会产生实际效果，限制获得医疗保健的机会 患者需要复杂而昂贵的服务，从而进一步分散了 为最脆弱的医疗保险提供按服务收费(FFS)的连续护理 受益人。零散的连续护理在以下方面尤其成问题 农村地区，那里的中断可能会在获得医疗服务方面留下很大缺口，如果 提供商的战略选择是受限的或提供商间的关系 (例如，从医院到疗养院)是薄弱的。 尽管BBA和BBRA的预期效果是控制成本，但有 是对乡村医院可能产生的一系列意外影响，他们的 以医院为基础的养老院与家庭健康机构的关系 医院与外部急性后和长期护理提供者之间的合作。这个 对乡村医院的意外影响可能涉及采用和/或 放弃融合战略，这反过来又可能影响对 以及农村医疗保险受益者的总体财务业绩 乡村医院。 我们早先对乡村医院及其急诊后和急症后的研究结果 长期护理战略提供了一个独特的基线，可以从这个基线来检查 BBA和BBRA的意外影响。我们计划解决三个具体目标： (1)评估BBA和BBRA对组织战略的影响 乡村医院要么多样化，进入长期护理领域，要么与外部 长期护理提供者；(2)评估BBA和BBRA相关的影响 高危人群排污时机和地点的策略性行为 在乡村医院治疗的医疗保险患者；以及(3)评估 BBA和BBRA相关战略变化对农村金融绩效的影响 医院。