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

项目摘要 美国农村、老年人和慢性病患者在获得高质量医疗服务方面面临重大挑战 在乎为了帮助生活在农村地区的五分之一的医疗保险受益人获得医疗保健， 医疗保险花费40亿美元用于向农村医疗保健提供者支付超过传统支付的特别费用。一 这种政策被称为农村附加支付，是《平价医疗法案》下的一个临时项目 该法案为农村县的家庭健康（HH）事件额外报销3%。尽管每年的成本 1亿美元，并计划在2022年前逐步淘汰，几乎没有证据表明这种支付附加费用是否 影响受益人的获取或患者的结果。我们的长期目标是了解医疗保险如何最好地 鼓励为农村受益人提供高质量的保健服务。实现这一目标的第一步 本研究的总体目标是检验农村附加支付是否增加了卫生保健的利用率 并改善患者的治疗效果。我们的中心假设是，HHA对农村支付附加做出了反应 通过增加农村地区的病人数量和/或增加农村地区的病人就诊次数， 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 一个具有以下具体目标的项目：1）调查农村支付附加对HH使用的影响 在住院治疗后，以及2）检查农村支付附加对农村HH的影响 患者结局。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年至2014年期间使用Medicare索赔和家庭医疗保险在住院后接受HH护理 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 调查农村支付附加是否对农村患者是否以及在何处接受产后护理产生影响的方法。 与城市患者相比，在因HH出院回家的受益人中，我们还将检查 每次发作的HH访问次数。目标2将采用跨时间匹配来识别一组相似的 在两个研究期间接受HH的农村受益人，并使用逻辑回归来检查概率 的功能改善和再住院/急诊科就诊。 拟议的工作是创新的，因为它是第一个研究，以评估农村支付附加的影响， 患者的访问和结果与严格的方法。这项工作意义重大，因为了解是否 农村支付附加影响患者的获得和结果将是重要的， 逐步取消附加项目将对农村受益人的健康产生负面影响。获得的见解 通过这项工作，可以向政策制定者提供有关未来为农村受益人提供保健服务的支付政策的信息。

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.