The Impact of the Medicare Shared Savings Program on Falls and Fall-Related Injuries Among the FFS Medicare Population

医疗保险共享储蓄计划对 FFS 医疗保险人群跌倒和跌倒相关伤害的影响

• 批准号: 10675237
• 负责人: Courtney Elizabeth Baird
• 金额: $ 4.32万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2024-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10675237
• 关键词: Impact; Medicare; Shared; Savings; Program

PROJECT SUMMARY To address perverse incentives in the fee-for-service (FFS) payment system, the 2010 Affordable Care Act (ACA) established a wide range of alternative payment models in which providers are reimbursed or penalized based on cost-efficiency, process quality, and health outcomes. One of the largest alternative payment models that was created by the ACA is the Accountable Care Organization (ACO), launched through the Medicare Shared Savings Program (MSSP) in 2012. A Medicare ACO is a group of doctors and other healthcare providers who agree to work together to improve the quality and cost of care by providing better-coordinated care to Medicare FFS patients across the care continuum. An MSSP ACO’s final reimbursement from Medicare is determined by both the ACO’s cost efficiency relative to its pre-determined benchmark expenditures and the ACO’s performance on more than 23 quality measures. As of January 1, 2022, there were 483 MSSP ACOs covering almost 30% of the entire FFS Medicare population. Existing evaluations of the MSSP program provide evidence that the program may be effective at improving processes of care and clinical outcomes and reducing utilization and spending. However, no research studies have evaluated the impact of MSSP ACOs on reducing the risk of falls and fall-related injuries among older adults. Annually, approximately 30% to 40% of community-dwelling adults aged 65 years and older experience a fall, which leads to an estimated $51 billion in spending. The MSSP ACOs have one specific preventative care quality indicator that aims to address the issue of falls among older adults: Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period (“ACO13”). The proposed study aims to evaluate the effect of the MSSP ACOs on the rate of screening for future fall risk and fall-related healthcare utilization among older (65+) FFS Medicare beneficiaries. To assess the impact of the MSSP ACOs on fall risk screening and fall-related healthcare utilization, we will conduct matched difference-in-differences analyses with year and state fixed effects using linked Medicare claims, CMS MSSP ACO Files, and SNF, IRF and HHA assessment data across 2010-2016. Specifically, we will pursue the following aims: (1) Compare the rate of screening for fall risk among older Medicare FFS beneficiaries who are attributed to MSSP ACOs as compared to those who are not attributed to MSSP ACOs; and (2) Compare rates of fall-related ED/outpatient visits, hospital admissions, and post-acute care utilization among older Medicare FFS beneficiaries who are attributed to MSSP ACOs as compared to those who are not attributed to MSSP ACOs. The expected outcome of this research is the first-ever national evidence of whether ACOs have improved care management and healthcare utilization among older adults who are at risk of falls. This study will provide comprehensive information to guide policy decisions as Medicare continues to modify ACO initiatives to incentivize value.

项目摘要 为了解决按服务收费（FFS）支付系统中的不正当激励，2010年《平价医疗法案》（Affordable Care Act） (ACA)建立了广泛的替代支付模式，其中提供者得到补偿或受到惩罚 基于成本效益、过程质量和健康结果。最大的替代支付模式之一 由ACA创建的是责任医疗组织（ACO），通过医疗保险推出 2012年的共享储蓄计划（MSSP）。医疗保险ACO是一组医生和其他医疗保健 同意通过提供更好的协调，共同努力提高护理质量和成本的提供者 在整个护理连续体中为Medicare FFS患者提供护理。MSSP ACO的最终报销 医疗保险是由ACO相对于其预定基准的成本效率决定的 在超过23个质量指标上，ACO的支出和绩效。截至2022年1月1日， 有483个MSSP ACO，覆盖了整个FFS医疗保险人口的近30%。对联合国系统的现有评价 MSSP计划提供的证据表明，该计划可能是有效的，在改善护理过程和临床 结果并减少利用率和支出。然而，没有任何研究评估了 MSSP ACOs关于降低老年人福尔斯和跌倒相关伤害的风险。每年，大约 30%至40%的65岁及以上的社区居住成年人经历过跌倒，这导致 预计支出510亿美元。MSSP ACO有一个特定的预防保健质量指标， 旨在解决老年人中的福尔斯问题： 在测量期间（“AC 0 13”）对未来跌倒风险进行筛查。拟议的研究旨在 评估MSSP ACO对未来跌倒风险筛查率和跌倒相关医疗保健的影响 老年人（65岁以上）FFS Medicare受益人的使用率。评估MSSP ACO对跌倒风险的影响 筛查和跌倒相关的医疗保健利用，我们将进行匹配的差异分析 使用关联的Medicare索赔、CMS MSSP ACO文件以及SNF、IRF和HHA， 2010-2016年的评估数据。具体而言，我们将追求以下目标：（1）比较 筛查归因于MSSP ACO的老年Medicare FFS受益人的跌倒风险， 与那些不归因于MSSP ACO的患者相比;（2）比较跌倒相关的艾德/门诊就诊率， 老年联邦医疗保险FFS受益人的住院率和急性期后护理利用率， 与不属于MSSP ACO的人相比，属于MSSP ACO的人。预期结果 这项研究是有史以来第一次全国性的证据，证明ACO是否改善了护理管理， 有福尔斯风险的老年人的医疗保健利用率。这项研究将提供全面的 信息来指导政策决策，因为Medicare继续修改ACO计划以激励价值。