Effect of post-acute care pay for performance in skilled nursing facilities on outcomes and disparities

熟练护理机构的急性后护理薪酬对结果和差异的影响

基本信息

批准号：
10581532
负责人：
Robert Edward Burke
金额：
$ 58.96万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-03-01 至 2025-11-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10581532
关键词：
Admission activity COVID-19 COVID-19 impact COVID-19 pandemic COVID-19 pandemic effects Caring Data Development Disparity Elderly Elements Face Fee-for-Service Plans Future Goals Health Health care facility Health system Home Hospitalization Hospitals Impaired cognition Incentives Individual Interview Length of Stay Medicare Methods Outcome Patient-Focused Outcomes Patients Performance Policies Policy Maker Prevalence Process Readiness Schedule Shapes Skilled Nursing Facilities Stress Structure Testing Time Vulnerable Populations acute care adverse outcome beneficiary care outcomes coronavirus disease cost design ethnic minority ethnic minority population evidence base hospital readmission improved improved outcome insight low socioeconomic status mortality patient population payment personal protective equipment pressure programs public health relevance racial minority racial minority population readmission rates resilience response stressor success

项目摘要

Project summary Post-acute care (PAC) is increasingly common and costly. One in five Medicare beneficiaries receives care after hospitalization in a skilled nursing facility at a cost of more than $28 billion annually. Unfortunately, more than 1 in 4 Medicare beneficiaries are readmitted to the hospital within 30 days, and these readmissions are associated with increased mortality. The Skilled Nursing Facility Value-Based Purchasing program (SNF VBP) ties Medicare reimbursements to SNF to their 30-day all-cause hospital readmission rates. Determining the effect of SNF VBP on patient outcomes is crucial for patients, health systems, and policymakers, and will inform the development and implementation of similar programs in other post-acute care settings. Evaluating potential unintended consequences of this policy is especially important because SNFs face significant financial pressure, and SNFs that care for large proportions of patients who are especially vulnerable to adverse outcomes (e.g. frail, cognitively impaired, poor, or racial and ethnic minority populations) are most likely to be penalized under the program, potentially leading to increased disparities. The COVID-19 pandemic may have magnified the effects of SNF VBP, acting as a second “stress” on SNFs already stressed by SNF VBP. There is an urgent need to determine the effect of SNF VBP on patient outcomes and on disparities, especially given the magnifying effect of COVID-19. Our long-term goal is to drive the delivery of high-value care for all older adults leaving the hospital. SNF VBP is among the first pay-for-performance programs in post- acute care settings. In order to improve the development and success of these policies, it is crucial to understand how their design and implementation influences outcomes. Our central hypothesis, based on preliminary data, is that SNF VBP achieves its intended effects at SNFs that were already high-performing, but has unintended and negative effects at low-performing SNFs. Our specific aims are to: 1) Determine the impact of SNF VBP on intended outcomes prior to the COVID-19 pandemic; 2) Determine the effect of SNF VBP on disparities in outcomes in vulnerable populations; 3) Determine how financial penalties from SNF VBP impacted COVID-19 readiness and outcomes; and 4) Assess key aspects of organizational context among SNFs that improved performance in SNF VBP and explore how this impacted their response to COVID-19. Accomplishing these aims will improve the design of future VBP initiatives, and lead to higher-value care for the growing number of vulnerable older adults receiving SNF care.

项目摘要急性后护理（PAC）越来越普遍且昂贵。五分之一的Medicare受益人获得护理在熟练的护士设施住院后，每年的费用超过280亿美元。不幸的是，更多超过四分之一的医疗保险受益人在30天内被送往医院，这些再入院是与死亡率增加有关。熟练的护理设施价值采购计划（SNF VBP）将Medicare的报销与SNF联系到其30天的全因医院再入院率。确定 SNF VBP对患者预后的影响对于患者，卫生系统和决策者至关重要，将会在其他急性后护理环境中告知类似计划的开发和实施。评估该政策的潜在意外后果尤其重要，因为SNF面临着重要的财务压力和SNF照顾大量的患者，这些患者特别容易受到伤害不利的结果（例如脆弱，认知受损，贫穷或种族和少数民族）是最多的可能会在该计划下受到处罚，可能导致差异增加。 19009年大流行可能已经放大了SNF VBP的影响，该作用是SNF已经压力的第二个“应力” VBP。迫切需要确定SNF VBP对患者结局和分布的影响，特别是考虑到COVID-19的放大效应。我们的长期目标是推动高价值的交付照顾所有老年人离开医院。 SNF VBP是邮政后第一个按绩效付费计划之一急性护理设置。为了改善这些政策的发展和成功，这对了解他们的设计和实施如何影响结果。我们的中心假设，基于初步数据是，SNF VBP在已经表现高的SNF上实现了其预期效果，但是在表现低的SNF上具有意外的和负面影响。我们的具体目的是：1）确定 SNF VBP对共同19-19大流行之前的预期结果的影响； 2）确定SNF的效果 VBP关于弱势群体结果的分布； 3）确定SNF VBP的经济罚款受影响的共同19号的准备和结果； 4）评估组织环境之间的关键方面 SNF改善了SNF VBP的性能并探讨这如何影响他们对Covid-19的反应。实现这些目标将改善未来VBP计划的设计，并导致高价值护理越来越多的弱势老年人接受SNF护理。