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

医疗保险报销变更后的急性后期成本和结果

基本信息

批准号：
7690027
负责人：
MELINDA J BUNTIN
金额：
$ 3.54万
依托单位：
RAND CORPORATION
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-03-01 至 2011-02-28
项目状态：
已结题

项目摘要

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.

描述（由申请人提供）：每年，超过 1000 万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、专业护理设施以及由家庭保健机构提供服务的家庭。这些受益人包括一些最虚弱和最易受伤害的老年人，其中许多人患有中风或跌倒等急性事件，所有这些人都被认为在没有进一步护理的情况下无法返回家中。受益人是否接受急性期后护理 (PAC) 以及他们接受的护理类型和强度很大程度上受到 Medicare 支付方式的影响。因此，支付方式的变化肯定会影响急性后期护理的结果。然而，这些影响有多大以及它们如何运作几乎是未知的。本研究的目的是回答这些重要问题。拟议的研究将使用关联的医疗保险管理数据来检查急性后护理付款的变化如何影响患有三种追踪病症（中风、髋部骨折和下肢关节置换）的患者的急性后护理利用、成本和结果。这些病症是接受急性后护理的前三种病症，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从具有三种追踪条件的医院急性护理中活着出院的 Medicare 患者的急性后护理的总体付款、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) 支付政策变化通过患者接受护理地点的变化与护理地点条件结果的变化来影响我们感兴趣的临床和财务结果的程度。了解 Medicare 支付方式的变化如何影响 PAC 的使用和结果非常重要，这样我们才能更充分地理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，而急性后期护理目前约占总数的 10%。随着国会寻求遏制医疗保险支出，急性期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可能如何影响老年人；这将是第一项考虑 PAC 支付系统变化期间所有 PAC 选项的研究。它还将第一个考虑支付变化对多种重要健康结果的影响。