Potential impact of bundled Medicare payments

本项目旨在确定全关节置换术（TJR）后增加TC利用率对资源消耗的财政影响，以住院时间（LOS）和支出来衡量。TJR是一种昂贵而普遍的手术，每年总共要花费医疗保险70亿美元进行35.4万次手术。在过去十年中，医院越来越频繁地利用过渡性护理（TC）单位来管理急性后康复。急性护理住院时间（LOS）有所下降，而TC的利用率有所提高。

This project seeks to determine the fiscal impact of increased TC utilization after total joint replacement surgery (TJR) on resource consumption as measured by length of stay (LOS) and expenditures. TJR is an expensive, prevalent surgery costing Medicare $7 billion per year for a total of 354,000 procedures. Over the last decade, hospitals have been utilizing transitional care (TC) units for the management of post-acute rehabilitation with increasing frequency. Acute care length of stay (LOS) has dropped while the utilization of TC has increased. The Health Care Financing Administration is considering an acute care and post-acute care bundled payment system. To study the potential fiscal impact of such a policy, this project proposes to examine the association between TC utilization and resource consumption controlling for patient, hospital and physician characteristics. To address the issue of selection bias, several candidate instrumental variables (IV) will be tested. 'vs when successfully identified are useful to approximate random assignment between the comparison groups. The recent Balanced Budget Amendment changes, and changes in TC utilization provides a unique opportunity to study the relationship between TC utilization and resource consumption. Two datasets will be used to refine and subsequently test the main hypothesis. The Medicare Current Beneficiary Dataset, in addition to administrative billing data, has detailed clinical (including function and comorbidity) and social support variables. Although sample size is restricted to 100 elective hip and knee replacements per year, this dataset will be useful in evaluating candidate instrumental variables. Final analyses will be performed using the larger national Medicare billing dataset.