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：
7575642
负责人：
Neeraj Sood
金额：
$ 46.74万
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，超过一千万的Medicare受益人从急诊医院出院到急性后护理机构，包括住院康复设施，熟练的护理设施以及提供家庭健康机构服务的房屋。这些受益人包括一些最狂热，最脆弱的长者，其中许多人遭受了诸如中风或跌倒之类的急性事件，所有这些人都被认为无法在没有进一步照顾的情况下返回家园。受益人是否接受急性后护理（PAC）以及他们获得的护理类型和强度都受到Medicare的付款方式的深刻影响。因此，付款变化肯定会影响急性后护理的结果。但是，这些效果的大小以及它们的操作方式几乎是未知的。这项研究的目的是回答这些重要问题。拟议的研究将使用链接的Medicare行政数据来研究急性后护理后的付款变化如何影响患有三种示踪剂条件的患者的急性后护理利用，成本和成果：中风，髋部骨折和下肢联合替代。这些条件是接受急性后护理后的三大条件，占所有受益人的25％。拟议的研究旨在分析：目标1）支付系统的变化如何影响整体付款，成本和结果，急性护理后的医疗保健患者的急性患者在医院的急性护理中活着出院，这三个示踪剂状况。目标2）选择PAC设置的决定因素，以及它们如何受到患者特征，出院医院特征，PAC设施特征和付款政策变化的影响。目标3）通过在护理现场有条件的情况下，患者获得护理与结果的变化的现场变化，付款政策变化的程度影响了我们的临床和财务成果。了解Medicare支付方法的变化如何影响PAC的使用和结果很重要，因此我们可以更充分地理解最近的政策计划的后果。此外，付款变化通常是由政策制定者对医疗保险计划成本的回应驱动的，而急性后护理现在约占该总数的10％。由于国会试图遏制医疗保险支出，因此急性后护理的付款可能会加剧。拟议的项目将帮助我们了解这种变化可能如何影响老年人；这将是第一项在PAC支付系统更改的时间段内考虑PAC选项的全部研究。这也将是第一个考虑付款变化对多个重要健康结果的影响的人。