Evaluating the Effects of CMS' Prospective Episode-Based "Bundling" Payment Model for Lower Limb Joint Replacement: Post-acute Care Setting, Costs and Patient Outcomes

评估 CMS 基于前瞻性事件的“捆绑”支付模式对下肢关节置换的效果：急性后护理环境、成本和患者结果

基本信息

批准号：
10217952
负责人：
TIMOTHY R DILLINGHAM
金额：
$ 37.09万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-15 至 2023-05-31
项目状态：
已结题

项目摘要

Prompted by the growth in Medicare spending and uncertainty about the effectiveness of post-acute care provided at alternative settings (e.g., inpatient rehabilitation facilities, skilled nursing facilities, home health agencies), the Center for Medicare and Medicaid Services (CMS) has established a mandatory, episode- based, prospective bundling payment model for persons undergoing elective joint arthroplasties, implemented as part of its Comprehensive Care for Joint Replacement (CJR) Rule of 2016. Bundles are based on inpatient DRGs and include all relevant Medicare costs during an episode-of-care, defined as the inpatient stay and 90 days post-acute discharge, regardless of post-acute care setting. In this application, we take advantage of the natural experiment afforded by CMS’ regional variation in implementation of the CJR Rule to examine the impact of bundling on service use, outcomes, and cost of care for the approximately 400,000 Medicare beneficiaries undergoing joint replacements every year. Specifically, our aims are: 1. To examine the effect of bundling on acute care length-of-stay, post-acute care discharge setting, and 90-day medical care costs among beneficiaries undergoing total knee (TKA) or hip (THA) arthroplasty, conditions targeted for bundled payments; 2. To estimate the effect of bundling on clinical and utilization outcomes at 12-months post-acute care discharge among patients with targeted conditions, and to quantify potential spillover effects on care and outcomes of patients with non-targeted musculoskeletal (hip fractures, amputations) and neurological (stroke) conditions; and 3. To estimate the impact of bundling on the value of care provided to patients with targeted and non-targeted conditions, and to discuss the implications of these relationships for post-acute care policy and program initiatives. Using difference-in-difference-in-difference techniques, we will estimate the effect of bundling on 12-month outcomes, including complications, medical (in)stability, re-hospitalizations, and mortality. Analyses conducted with serial cohorts of patients with non-targeted conditions will provide additional comparison groups and enable us to estimate possible spillover effects of the CJR Rule. Results from this study will provide important “real time” information for all interested in the challenges of providing effective post-acute care to the large and growing number of elderly persons requiring rehabilitation, including government, policy-makers, payers, and consumers. The findings will also be relevant in the current ACA- replace and repeal environment, which is expected to further reduce access to and reimbursement for these and other post-acute care services.

受到医疗保险支出的增长和急性后护理有效性的不确定性的推动在替代环境中提供（例如住院康复设施、熟练护理设施、家庭保健设施）机构），医疗保险和医疗补助服务中心（CMS）建立了一个强制性的、情节- 实施基于前瞻性捆绑支付模式的选择性关节置换术患者作为 2016 年关节置换综合护理 (CJR) 规则的一部分。套餐基于住院患者 DRG 并包括护理期间的所有相关 Medicare 费用，定义为住院时间和 90 急性出院后的天数，无论急性后护理环境如何，在此应用程序中，我们利用了 CMS 在实施 CJR 规则方面的区域差异提供了自然实验，以检验捆绑对大约 400,000 名医疗保险患者的服务使用、结果和护理成本的影响具体来说，我们的目标是： 1. 检查关节置换术的效果。捆绑急性护理住院时间、急性护理出院后设置和 90 天医疗费用在接受全膝关节置换术（TKA）或髋关节置换术（THA）的受益人中，捆绑治疗的目标条件 2. 评估捆绑治疗对急性期后 12 个月的临床和使用结果的影响具有目标病症的患者的护理出院情况，并量化对护理和护理的潜在溢出效应非目标肌肉骨骼（髋部骨折、截肢）和神经系统（中风）患者的结果条件；以及 3. 评估捆绑对向有针对性的患者提供的护理价值的影响和非目标病症，并讨论这些关系对急性后护理政策的影响和计划举措。我们将使用双重差分技术来估计其效果。捆绑 12 个月的结果，包括并发症、医疗（不稳定）稳定性、再住院和对非目标疾病患者的连续队列进行的分析将提供额外的信息。比较组并使我们能够据此估计 CJR 规则结果可能产生的溢出效应。研究将为所有对提供有效性的挑战感兴趣的人提供重要的“实时”信息为大量且不断增加的需要康复的老年人提供急性后护理，包括政府、政策制定者、付款人和消费者也将与当前的《平价医疗法案》相关。更换和废除环境，预计将进一步减少这些资源的获取和报销和其他急症后护理服务。

项目成果

期刊论文数量（8）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Race, ethnicity, and utilization of outpatient rehabilitation for treatment of post COVID-19 condition.

种族、族裔以及门诊康复治疗 COVID-19 后病情的利用。

DOI：
发表时间：
2022-11
期刊：
影响因子：
0
作者：
Hentschel, Claudia B;Abramoff, Benjamin A;Dillingham, Timothy R;Pezzin, Liliana E
通讯作者：
Pezzin, Liliana E

Hemiarthroplasty Versus Total Hip Arthroplasty for Femoral Neck Fracture in Elderly Patients: Twelve-Month Risk of Revision and Dislocation in an Instrumental Variable Analysis of Medicare Data.

老年患者股骨颈骨折的半髋关节置换术与全髋关节置换术：医疗保险数据工具变量分析中的 12 个月翻修和脱位风险。

DOI：
发表时间：
2023-11-01
期刊：
影响因子：
0
作者：
Edelstein, Adam I;Dillingham, Timothy R;McGinley, Emily L;Pezzin, Liliana E
通讯作者：
Pezzin, Liliana E

The Association of multiple sclerosis, traumatic brain injury, and spinal cord injury to acute and long COVID-19 outcomes.

多发性硬化症、创伤性脑损伤和脊髓损伤与急性和长期 COVID-19 结局的关联。

DOI：
发表时间：
2023-12-25
期刊：
影响因子：
0
作者：
Abramoff, Benjamin A;Hentschel, Claudia;Dillingham, Ingram A;Dillingham, Timothy;Baraniecki;Williams, Asha;Pezzin, Liliana E
通讯作者：
Pezzin, Liliana E

Inpatient Rehabilitation Outcomes After Severe COVID-19 Infections: A Retrospective Cohort Study.

严重 COVID-19 感染后的住院康复结果：一项回顾性队列研究。

DOI：
发表时间：
2021-12-01
期刊：
影响因子：
3
作者：
Abramoff, Benjamin A;Dillingham, Timothy R;Caldera, Franklin E;Ritchie, Marylyn D;Pezzin, Liliana E
通讯作者：
Pezzin, Liliana E

Psychological and Cognitive Functioning Among Patients Receiving Outpatient Rehabilitation for Post-COVID Sequelae: An Observational Study.

因新冠肺炎后遗症接受门诊康复治疗的患者的心理和认知功能：一项观察性研究。

DOI：
发表时间：
2023-01
期刊：
影响因子：
4.3
作者：
Abramoff, Benjamin A;Dillingham, Timothy R;Brown, Lily A;Caldera, Franklin;Caldwell, Katherine M;McLarney, Mitra;McGinley, Emily L;Pezzin, Liliana E
通讯作者：
Pezzin, Liliana E