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

项目总结 急诊后护理(PAC)越来越普遍，费用也越来越高。五分之一的联邦医疗保险受益人接受医疗保健 在一家技术熟练的护理机构住院后，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天内重新入院，这些重新入院的人是 与死亡率增加有关。技能护理设施价值采购计划(SNF VBP) 将医疗保险报销与SNF的30天全原因再住院率联系起来。确定 SNF VBP对患者预后的影响对患者、卫生系统和政策制定者至关重要，并将 告知在其他急性后护理环境中制定和实施类似方案的情况。正在评估 这一政策的潜在意外后果尤其重要，因为瑞士央行面临着重大的 经济压力，以及照顾大部分患者的SNF，这些患者特别容易受到 不良后果(例如，虚弱、认知障碍、贫穷或种族和少数民族人口)是最严重的 可能会在该计划下受到惩罚，可能会导致差距扩大。新冠肺炎大流行 可能放大了SNF VBP的影响，对已经受到SNF压力的SNF起到了第二个“压力” 越南船民。迫切需要确定SNF VBP对患者预后和差异的影响， 尤其是考虑到新冠肺炎的放大效应。我们的长期目标是推动高价值的交付 照顾所有出院的老年人。SNF VBP是第一批按绩效付费的项目之一 急诊护理环境。为了改进这些政策的发展和成功，至关重要的是 了解它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SNF实现了预期的效果，尽管SNF已经很高的表现，但 对表现不佳的SNF有意想不到的负面影响。我们的具体目标是：1)确定 新冠肺炎大流行前新诺威VBP对预期结果的影响；2)确定新诺威的效果 关于弱势人群结果差异的VBP；3)确定SNF VBP的经济处罚 影响新冠肺炎就绪性和成果；以及4)评估组织环境的关键方面，包括 SNF表示，这提高了他们在三菱NFVBP的表现，并探索这如何影响他们对新冠肺炎的回应。 实现这些目标将改进未来越南船民计划的设计，并导致对 越来越多的易受伤害的老年人接受SNF护理。

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.