The impact of post acute care payment changes on access and outcomes

急性护理后支付变化对获取和结果的影响

基本信息

批准号：
10328866
负责人：
Natalie Elizabeth Leland
金额：
$ 62.8万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-01-15 至 2024-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10328866
关键词：
Acute Address Administrator Alzheimer&apos s Disease Alzheimer&apos s disease diagnosis Back Behavior Caring Categories Characteristics Clinical Communities Complex Data Diagnostic Elderly Focus Groups Frontline worker Funding Goals Growth Health Health Personnel Health Services Accessibility Hip Fractures Home Home Health Agency Hospitalization Hospitals Incentives Individual Interview Link Location Measures Medical Medicare Medicare claim Methodology Methods Modeling Natural experiment Occupational Therapy Outcome Patient Selection Patients Pattern Physical therapy Policies Process Provider Published Comment Quality Control Quality of Care Recovery of Function Rehabilitation therapy Rural Services Skilled Nursing Facilities Speech Therapy Subgroup System Time United States Centers for Medicare and Medicaid Services Vulnerable Populations acute care base care delivery care outcomes care providers care systems design dual eligible ethnic minority financial incentive functional status geographic difference hospital readmission medically necessary care multiple data sources patient expectation patient population patient subsets payment racial and ethnic racial minority rapid growth rehabilitative care response rural patients rural residence service delivery stakeholder perspectives

项目摘要

Project Summary/Abstract Substantial changes in Medicare payment policies are occurring for post-acute care (PAC), which provides a bridge from the hospital to home for individuals who require medical and rehabilitation (i.e., physical, occupational, and speech therapy) services to transition successfully back to the community. Skilled nursing facilities (SNFs) and home health agencies (HHAs) account for almost 80% of PAC spending. Rapid growth in PAC spending has been driven largely by prior payment systems that incentivized therapy services. However, new payment models were implemented in October 2019 for SNFs and January 2020 for HHAs that attempt to address (a) the growth in spending and (b) the potential for misuse of therapy services. These new models remove incentives for therapy but do not include controls for quality (e.g., community discharge, readmissions). In response, PAC stakeholders have raised concerns that payment reform may differentially impact access to and quality of care for vulnerable populations (e.g., racial and ethnic minorities, dually-eligible, rural-residing) and diagnostic subgroups (e.g., dementia/Alzheimer’s, hip fracture) due to changing reimbursements. While the new models are intended to promote appropriate and efficient care, the actual impact of payment reform is unknown. We hypothesize that SNFs and HHAs will not respond uniformly to changing reimbursements and that the new payment models will adversely impact quality of care for some, but not all, patient populations. Therefore, our overarching goal is to evaluate the impact of payment reform overall and among vulnerable populations and diagnostic subgroups. Using a natural experiment design that capitalizes on the timing of payment reform and a mixed methods approach that uses rich qualitative data collected from SNF and HHA staff and patients, as well as extensive patient-level Medicare claims and assessment data, we will: Aim 1: Identify SNF and HHA organizational responses to payment reform by quantifying changes in therapy staffing and payer mix pre-post payment reform and qualitatively exploring stakeholder perspectives on organizational processes, barriers, and facilitators to providing high-quality care under the new models. Aim 2: Characterize access to SNF and HHA after hospital discharge and utilization of therapy within SNF/HHA pre-post-payment reform overall and for vulnerable populations and diagnostic subgroups. Aim 3: Quantify the association between therapy utilization and quality outcomes (e.g., functional change) pre-post payment reform overall and for vulnerable populations and diagnostic subgroups. Rigorous qualitative and quantitative methodologies will allow us to (a) evaluate whether payment reform has the intended result of incentivizing efficient care and (b) identify any unintended consequences related to disparities in access to care and compromised quality. Findings will address stakeholders’ concerns and provide critical information to policymakers, providers, system leaders, and payers on the impact of payment reform on patient access and quality across patient populations, including the most vulnerable.

项目摘要/摘要急性后护理（PAC）正在发生Medicare支付政策的实质性变化，这提供了从医院到家的桥梁需要医疗和康复的个人（即身体，身体，职业和语音疗法）成功地回到社区设施（SNF）和家庭健康机构（HHA）占PAC支出的80％ PAC支出是通过激励治疗服务的先前支付系统驱动的。 SNFS于2019年10月实施了新的付款模式，2020年1月为此试图尝试（a）支出的增长和（b）滥用治疗服务的潜力删除治疗的激励措施，但不包括质量控制的控制（例如，社区出院，再读）。作为回应，PAC利益相关者提出了担心付款改革可能会影响访问的问题和对弱势群体的护理质量（例如，种族和少数民族，符合双重资格，农村地区）和诊断亚组（例如，痴呆症/阿尔茨海默氏症，髋部骨折）新模型旨在促进适当有效的护理，付款改革的实际影响是IS是未知。新的支付模型将对某些但不是全部患者人群的护理质量产生不利影响。因此，我们的总体目标是评估总体付款改革的影响以及脆弱的影响种群和诊断亚组。付款改革和一种使用SNF和HHA的丰富定性数据收集器的混合方法方法员工和患者以及广泛的患者级医疗保险索赔和评估数据，我们将：目标1：通过量化治疗的变化来确定SNF和HHA组织对付款改革的反应员工和付款人组合前支付改革和定性探索利益相关者的观点组织过程，障碍和促进者在新模型下提供高质量的护理。 AIM 2：特征是出院后进入SNF和HHA的特征 SNF/HHA预付款改革整体以及脆弱的人群和诊断子组。目标3：量化治疗利用与质量结果之间的关联（例如功能变化）总体上的支付前付款改革以及弱势群体和诊断子组。严格的定性和定量方法将使我们能够（a）评估付款改革是否拥有激励有效护理的预期结果以及（b）确定与获得护理和妥协的差异将解决利益相关者的关注点向政策制定者，提供商，系统领导者和付款人提供关键信息，以付款改革患者群体的患者访问和质量，包括最脆弱的患者。