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

描述（由申请人提供）：每年，超过1000万的医疗保险受益人从急症护理医院出院，进入急症后护理机构，包括住院康复设施、专业护理设施和家庭健康机构提供服务的家庭。这些受益人包括一些最虚弱和最脆弱的老年人，其中许多人患有中风或跌倒等急性事件，所有人都被判定无法在没有进一步护理的情况下返回家园。受益人是否接受急性后护理（PAC）以及他们接受护理的类型和强度受到医疗保险支付方式的深刻影响。因此，支付的变化肯定会影响急性后护理的结果。然而，这些影响有多大以及它们是如何起作用的，实际上是未知的。这项研究的目的就是要回答这些重要的问题。拟议的研究将使用相关的医疗保险管理数据来检查急性后护理支付的变化如何影响急性后护理的使用、成本和三种示踪条件患者的结果：中风、髋部骨折和下肢关节置换术。这些情况是接受急性后护理的前三种情况，合计占接受PAC的所有受益人的25%。拟议的研究旨在分析：目标1)支付系统的变化如何影响患有三种示踪条件的急性护理住院的医疗保险患者的急性后护理的总体支付、成本和结果。目标2)PAC设置选择的决定因素，以及它们如何受到患者特征、出院医院特征、PAC设施特征和支付政策变化的影响。目标3)通过患者接受护理地点的变化与护理地点条件下结果的变化，支付政策变化对我们感兴趣的临床和财务结果的影响程度。了解医疗保险支付方式的变化如何影响PAC的使用和结果是很重要的，这样我们就可以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所驱动的，目前急症后护理约占总额的10%。由于国会试图控制医疗保险支出，急症后护理的支付很可能会收紧。拟议的项目将帮助我们了解这些变化对老年人的影响；这将是第一个在PAC支付系统发生变化的时期内考虑PAC各种选择的研究报告。它还将是第一个考虑支付变化对多种重要健康结果的影响的报告。

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.