Post-Acute Costs and Outcomes After Medicare's Reimbursement Changes

医疗保险报销变更后的急性后期成本和结果

• 批准号: 7354249
• 负责人: MELINDA J BUNTIN
• 金额: $ 45.4万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-03-01 至 2011-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7354249
• 关键词: Accounting; Acute; Address; Affect; Aging; Area; Back; Behavioral Model; Build-it; Care given by nurses; Caring; Characteristics; Clinical; Condition; Congresses; Data; Data Set; Elderly; Event; Goals; Growth; Health; Hip Fractures; Home Health Agency; Home environment; Hospitals; Improve Access; Inpatients; Institution; Institutionalization; Link; Lower Extremity; Medicare; Methods; Outcome; Patient Discharge; Patients; Policies; Provider; Range; Rehabilitation therapy; Replacement Arthroplasty; Research; Services; Site; Skilled Nursing Facilities; Stroke; System; Time; Tracer; Update; Vulnerable Populations; base; beneficiary; cost; cost effectiveness; falls; interest; medical schools; member; mortality; payment; programs; response

DESCRIPTION (provided by applicant): Each year, more than ten million Medicare beneficiaries are discharged from acute care hospitals into post-acute care settings including inpatient rehabilitation facilities, skilled nursing facilities, and homes with services from home health agencies. These beneficiaries include some of the frailest and most vulnerable elders, many of whom have suffered from an acute event such as a stroke or a fall, all of whom are judged unable to return to their homes without further care. Whether beneficiaries receive post-acute care (PAC) and the type and intensity of care they receive is profoundly influenced by Medicare's methods of payment. Consequently, payment changes will certainly affect the outcomes of post-acute care. How large those effects are and how they operate, however, are virtually unknown. The goal of this study is to answer these important questions. The proposed study will use linked Medicare administrative data to examine how changes in payment for post-acute care affected post-acute care utilization, costs, and outcomes for patients with three tracer conditions: stroke, hip fracture, and lower extremity joint replacement. These conditions are the top three conditions receiving post-acute care and together account for 25% of all beneficiaries receiving PAC. The proposed study aims to analyze: Aim 1) How changes in payment systems affected overall payments for, costs of, and outcomes of episodes of post-acute care for Medicare patients discharged alive from an acute care stay in a hospital with the three tracer conditions. Aim 2) The determinants of choice of PAC setting, and how they are affected by patient characteristics, discharging hospital characteristics, PAC facility characteristics, and payment policy changes. Aim 3) The extent to which payment policy changes affected our clinical and financial outcomes of interest through changes in the sites where patients received care versus changes in outcomes conditional on care site. Understanding how changes in Medicare's payment methods have affected use of and outcomes of PAC is important so that we can more fully appreciate the consequences of recent policy initiatives. Moreover, payment changes are usually driven by policymakers' responses to the cost of the Medicare program, and post-acute care now represents about 10% of that total. As Congress seeks to contain Medicare spending, payment for post-acute care may well tighten. The proposed project will help us to understand how such changes might affect seniors; it will be the first study to consider the full range of PAC options over the time period in which the PAC payment systems changed. It will also be the first to consider the effects of payment changes on multiple important health outcomes.

描述(申请人提供)：每年有1000多万医疗保险受益人从急性护理医院出院，进入急性后护理环境，包括住院康复机构、熟练护理机构和接受家庭保健机构服务的家庭。这些受益人包括一些最虚弱和最脆弱的老年人，他们中的许多人都遭受过中风或跌倒等急性事件的痛苦，他们都被判定在没有进一步照顾的情况下无法回家。受益人是否接受急性后护理(PAC)以及他们接受的护理的类型和强度受到联邦医疗保险的支付方法的深刻影响。因此，支付方式的变化肯定会影响急诊后护理的结果。然而，这些影响有多大，以及它们是如何运作的，几乎是未知的。本研究的目的就是回答这些重要问题。这项拟议的研究将使用相关的医疗保险管理数据来检查急诊后护理费用的变化如何影响中风、髋部骨折和下肢关节置换等三种示踪性疾病患者的急诊后护理利用率、成本和结果。这些情况是接受急症后护理的三大病症，合共占所有接受PAC的受助人的25%。这项拟议的研究旨在分析：目的1)支付系统的变化如何影响在具有三种示踪条件的医院中因急性护理住院而活着出院的医疗保险患者的急性后护理事件的总体支付、成本和结果。目的2)选择PAC设置的决定因素，以及患者特征、出院特征、PAC设施特征和支付政策变化对它们的影响。目的3)支付政策的变化通过患者接受护理的地点的变化与有条件的护理地点的结果的变化来影响我们感兴趣的临床和财务结果的程度。了解医疗保险支付方式的变化如何影响PAC的使用和结果非常重要，这样我们才能更充分地了解最近政策举措的后果。此外，支付方式的变化通常是由政策制定者对医疗保险计划成本的反应推动的，而急诊后护理现在约占总数的10%。随着国会寻求控制医疗保险支出，急诊后护理的支出很可能会收紧。建议中的计划将有助我们了解这些改变对长者可能造成的影响；这将是第一项研究，全面考虑政府账目委员会在一段时间内改变支付系统的各种方案。它还将第一次考虑支付变化对多种重要健康结果的影响。