Post-BBA Changes in Rural Hospital LTC Strategies

描述（由申请人提供）：正在实施的1997年 平衡预算法（BBA）和1999年平衡预算改进法（BBRA） 继续对医院的报销产生不利影响， 急性/长期护理提供者。每种情况下的补偿激励措施 可能会限制医疗保险的实际效果 病人需要复杂和昂贵的服务，从而进一步分散 为最弱势群体提供的按服务收费（FFS）连续护理 受益人。支离破碎的连续护理尤其成问题， 在农村地区，中断可能会在获得保健方面留下很大差距， 供应商的战略选择受到约束或供应商之间的关系 (e.g.,医院到疗养院）都很薄弱。 虽然BBA和BBRA的预期效果是控制成本，但 对农村医院可能产生的各种意外影响， 以医院为基础的护理之家和家庭保健机构， 医院和外部急性期后和长期护理提供者之间的关系。的 对农村医院的意外影响可能涉及其采用和/或 放弃一体化战略，这反过来又可能影响对儿童的照顾， 农村医疗保险受益人以及 农村医院。 我们早期对农村医院及其急性期后和 长期护理战略提供了一个独特的基线， BBA和BBRA的非预期影响。我们计划实现三个具体目标： (1)评估BBA和BBRA如何影响组织战略 农村医院要么多样化，提供长期护理，要么与外部 （2）评估BBA和BBRA相关的影响 战略行为的时间和安置出院之间的风险 在农村医院治疗的医疗保险患者;（3）评估 BBA和BBRA相关战略变化对农村金融绩效的影响 医院的

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.