The Impact of the Medicare Home Health Rural Add-on payment on Beneficiary Access and Health Outcomes

医疗保险家庭健康农村附加付款对受益人获取和健康结果的影响

• 批准号: 9815777
• 负责人: Lacey Loomer
• 金额: $ 4.31万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9815777
• 关键词: Impact; Medicare; Home; Health; Rural

PROJECT SUMMARY Rural, elderly and chronically ill Americans face significant challenges to accessing high quality health care. To help maintain access to health care for the 1 in 5 Medicare beneficiaries who live in rural areas, Medicare spends $4 billion on special payments to rural health care providers above traditional payments. One such policy, known as the rural payment add-on, has been a temporary program under the Affordable Care Act that reimburses an additional 3% for home health (HH) episodes in rural counties. Despite an annual cost of $100 million, and a scheduled phase out by 2022, there is little evidence about whether this payment add-on impacts beneficiaries’ access or patient outcomes. Our long term goal is to understand how Medicare can best incentivize the provision of high quality health care for rural beneficiaries. The first step to achieving this goal and the overall objective of this study is to examine whether the rural payment add-on increases HH utilization and improves patient outcomes. Our central hypothesis is that HHAs responded to the rural payment add-on by increasing the volume of patients served in rural areas and/or increasing the number of visits to patients in rural areas and that these additional services may improve outcomes. To evaluate our hypothesis, we propose a project with the following specific aims: 1) Investigate the effect of the rural payment add-on on HH utilization following an inpatient hospitalization, and 2) Examine the effect of the rural payment add-on on rural HH patient outcomes. To achieve these objectives, we propose to study Medicare fee-for-service beneficiaries, who received HH care following a hospitalization between 2007 and 2014 using Medicare claims and Home Health Outcomes and Assessment Information Set data. The first aim will use a difference-in-differences approach to investigate if the rural payment add-on had an impact on if and where rural patients received post- acute care compared to urban patients. Among beneficiaries discharged home with HH, we will also examine the number of HH visits per episode. Aim 2 will employ cross-temporal matching to identify a similar group of rural beneficiaries who received HH in both study periods and use logistic regression to examine the probability of functional improvement and re-hospitalization/emergency department visits after the payment add-on. The proposed work is innovative because it is the first study to evaluate the impact of the rural payment add-on on patient access and outcomes with rigorous methods. This work is significant because understanding whether the rural payment add-on impacts patient access and outcomes will be important in assessing what possible negative outcomes the phase out of the add-on will have on the health of rural beneficiaries. Insights gained through this work may inform policymakers regarding future payment policies for HH for rural beneficiaries.

项目总结 美国农村、老年人和慢性病患者在获得高质量医疗保健方面面临巨大挑战 关心。为了帮助生活在农村地区的五分之一的医疗保险受益者获得医疗保健， 医疗保险在向农村医疗保健提供者支付传统付款之外，还向其支付了40亿美元的特别付款。一 这种被称为农村支付附加项目的政策，一直是《平价医疗法案》下的一项临时计划 这将为农村县的家庭健康(HH)事件额外报销3%。尽管每年的成本是 1亿美元，并计划在2022年逐步淘汰，几乎没有证据表明这一支付附加组件 影响受益人的机会或患者的结果。我们的长期目标是了解联邦医疗保险如何才能 激励为农村受益者提供高质量的医疗保健。实现这一目标的第一步 这项研究的总体目标是检查农村支付附加组件是否提高了HH利用率 并改善患者的预后。我们的中心假设是，他对农村支付附加服务做出了回应 通过增加农村地区的就诊量和/或增加农村地区患者的就诊次数 他说，在农村地区，这些额外的服务可能会改善结果。为了评估我们的假设，我们建议 一个具体目标如下的项目：1)调查农村支付附加服务对卫生保健服务利用率的影响 住院后，以及2)检查农村支付附加项目对农村卫生保健的影响 病人的结果。为了实现这些目标，我们建议研究医疗保险按服务收费的受益人， 在2007至2014年间使用Medicare Claims和Home住院后接受HH护理的人 健康结果和评估信息集数据。第一个目标将使用差异中的差异 调查农村支付附加服务是否对农村患者是否以及在哪里接受后支付有影响的方法 与城市患者相比，急诊护理。在获释回家的HH患者中，我们还将研究 每集HH的访问量。目标2将使用跨时间匹配来识别类似的一组 在两个研究期间接受HH的农村受益人，并使用Logistic回归检验概率 在支付附加费用后，功能改善和再次住院/急诊科就诊的费用。这个 拟议的工作具有创新性，因为这是第一项评估农村支付附加组件对 以严谨的方法接触患者和治疗结果。这项工作意义重大，因为了解 农村支付的附加影响和结果将在评估可能发生的情况时发挥重要作用 逐步取消附加服务将对农村受益者的健康产生负面影响。获得洞察力 通过这项工作，可以向政策制定者通报未来农村受益者的卫生保健支付政策。