Vertical Integration and Care Coordination in Post-Acute Care Markets

急症后护理市场的垂直整合和护理协调

• 批准号: 8626101
• 负责人: Neeraj Sood
• 金额: $ 69.76万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-15 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8626101
• 关键词: Accounting; Acute; Address; Caring; Characteristics; Data; Dimensions; Expenditure; Face; Health; Health Care Costs; Health Personnel; Health Planning; Healthcare; Hip Fractures; Hospitals; Inpatients; Knowledge; Lead; Link; Lower Extremity; Marketing; Medicare; Nature; Outcome; Parents; Patient Care; Patient Monitoring; Patient Selection; Patients; Policies; Population; Procedures; Provider; Rehabilitation therapy; Replacement Arthroplasty; Research; Research Personnel; Research Support; Risk; Site; Skilled Nursing Facilities; Stroke; Time; Tracer; Translating; Ursidae Family; base; beneficiary; cost; health care delivery; hip replacement arthroplasty; hospital readmission; improved; payment; pressure; public health relevance; response; stem; trend

Each year millions of Medicare beneficiaries are discharged from acute care hospitals into post-acute care settings including inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs). Medicare expenditures for post-acute care have more than doubled in the last decade, from $26.6 billion in 2001 to $63.5 in 2011. Several policy analysts are concerned that the rapid expansion in post-acute care costs has not translated into better outcomes. Some posit that the likely culprits for this problem are the way Medicare reimburses for health care and the resulting fragmented nature of health care delivery. Under current Medicare payment policy acute care hospitals, SNFs, and IRFs each receive a separate payment for providing acute and post-acute care to patients. More importantly, currently Medicare does not reimburse any entity for coordinating patient transitions across providers. In response to these concerns the Affordable Care Act included several Medicare reforms such as penalties for readmissions, "Accountable Care Organizations", and "Bundled Payment" to improve care coordination, particularly following hospital discharge. Under each of these reforms, health care providers bear the financial risk of poor patient outcomes stemming from poor coordination or under-provision of care. These Medicare reforms have provided an impetus to providers and even private health plans to implement changes aimed towards improving care coordination. It is likely that hospitals will attempt to improve coordination and efficiency after payment reform by establishing closer relationships with other health care providers. As the administrative burden from increased coordination and monitoring of patients across sites is likely to be considerable, many researchers have posited that such reforms are likely to lead to an increase in the market share of vertically integrated or hospital based IRFs or SNFs - where patients receive acute and post-acute care within the same facility. However, there is little evidence on the causal effect of receiving vertically integrated care (that is, receiving post-acute care within the same facility that provided acute care) on patient outcomes and health care costs. Moreover, the effects of receiving vertically integrated care are likely to evolve over time as providers face increasing financial pressure from Medicare and private health plans to coordinate care. The specific aims of this project are to advance knowledge on the potential effects of receiving vertically integrated care. In particular, we propose to: 1. Estimate the causal effect of receiving vertically integrated care for patients admitted to SNFs on patient outcomes and health care costs 2. Estimate the causal effect of receiving vertically integrated care for patients admitted to IRFs on patient outcomes and health care costs 3. Estimate the extent to which the causal effects of receiving vertically integrated care evolve overtime as efforts to coordinate care gain momentum 4. Examine trends in vertical integration of care and use results from Aims 1 to 3 to examine the contribution of these trends to aggregate trends in patient outcomes and health care costs The proposed project will use linked Medicare data from 2003-2015 and will focus on three "tracer" conditions: stroke, hip fracture, and lower extremity joint replacement. The results will provide important evidence on the potential effects of vertical integration and proposed Medicare reforms aimed at improving care coordination.

每年，数百万的医疗保险受益人都从急诊医院出院到急性后护理 包括住院康复设施（IRF）和熟练护理设施（SNFS）在内的设置。 Medicare 在过去的十年中，急性后护理的支出增加了一倍以上，从2001年的266亿美元到 $ 63.5在2011年。几位政策分析师担心急性后护理成本的快速扩张尚未 转化为更好的结果。有些人认为这个问题的可能造成罪魁祸首是Medicare的方式 偿还医疗保健和由此产生的医疗保健交付性质分散的性质。在当前的医疗保险下 付款政策急性护理医院，SNFS和IRF分别为提供急性和 急性护理给患者。更重要的是，目前Medicare并未偿还任何实体 协调跨提供者的患者过渡。为了回应这些问题，《平价医疗法案》 包括几项Medicare改革，例如对再选中的处罚，“负责任的护理组织”和 “捆绑付款”以改善护理协调，特别是在出院后。每个 这些改革，医疗保健提供者承担了因贫穷而导致患者结果差的财务风险 协调或护理少。这些医疗保险改革为提供者和 甚至私人健康计划，以实施旨在改善护理协调的变更。 医院可能会试图通过建立付款改革后提高协调和效率 与其他医疗保健提供者的关系更紧密。作为增加协调的行政负担 许多研究人员认为，对跨站点的患者进行监测可能很大 改革可能导致垂直整合或基于医院的IRF或 SNFS-患者在同一设施内接受急性和急性护理。但是，几乎没有 有关接受垂直整合护理的因果影响的证据（即接受急性后护理 提供患者预后和医疗保健费用的相同设施。而且， 随着提供者面临日益增加的财务压力，接收垂直整合的护理可能会随着时间的流逝而发展 从Medicare和私人健康计划来协调护理。该项目的具体目的是进步 了解接受垂直整合护理的潜在影响。特别是，我们建议： 1。估计接受纳入SNF的患者的垂直整合护理的因果关系 患者的结果和医疗保健费用 2。估计接受患者IRF的患者接受垂直整合护理的因果关系 成果和医疗保健费用 3。估计接收垂直整合护理的因果影响的程度 作为协调护理的努力 4。检查目的1至3的护理和使用结果的垂直整合趋势以检查 这些趋势对患者预后和医疗保健成本总体趋势的贡献 拟议的项目将在2003 - 2015年使用链接的Medicare数据，并将重点放在三个“示踪剂”条件下： 中风，髋部骨折和下肢置换。结果将提供有关 垂直整合和拟议的Medicare改革的潜在影响旨在改善护理协调。