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

基本信息

批准号：
9279039
负责人：
Neeraj Sood
金额：
$ 69.78万
依托单位：
UNIVERSITY OF SOUTHERN CALIFORNIA
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-06-15 至 2019-12-31
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): 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 (tha 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.

描述（由申请人提供）：每年数以百万计的医疗保险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（IRFS）和熟练的护理设施（SNFS）。在过去的十年中，急性后护理的医疗保险支出增加了一倍以上，从2001年的266亿美元增加到2011年的63.5美元。几位政策分析师担心，急性后护理成本的迅速增长并未转化为更好的结果。有些人认为，此问题的可能造成罪魁祸首是Medicare偿还医疗保健的方式以及医疗保健提供的零散性质。根据当前的医疗保险支付政策，急性护理医院，SNF和IRF分别为患者提供急性和急性护理。更重要的是，目前，Medicare并未偿还任何实体，以协调各个提供者的患者过渡。为了应对这些问题，《平价医疗法案》包括几项医疗保险改革，例如对再入院，“责任护理组织”和“捆绑付款”，以改善护理协调，尤其是在出院后。在这些改革中，医疗保健提供者承担了由于协调不佳或护理不足而产生的不良患者结果的财务风险。这些医疗保险改革为提供者甚至私人健康计划提供了动力，以实施旨在改善护理协调的变更。医院可能会试图通过与其他医疗保健提供者建立更紧密的关系来提高付款改革后的协调和效率。由于跨站点对患者的协调和监测的行政负担可能很大，许多研究人员认为，这种改革很可能导致垂直整合或基于医院的IRFS或SNF的市场份额增加 - 患者在同一机构内获得急性和急性护理。但是，几乎没有证据表明接受垂直整合护理的因果影响（THA是在提供急性护理的同一设施中接受急性后护理的原因）。此外，随着提供者面临医疗保险和私人健康计划的财务压力增加以协调护理，获得垂直综合护理的影响可能会随着时间的流逝而发展。该项目的具体目的是提高有关接受垂直整合护理的潜在影响的知识。特别是，我们建议：1。估计接受SNF的患者接受垂直整合的护理的因果关系，并估计接受IRF的患者垂直整合护理的因果关系的因果关系，而IRF的患者对患者的成果和卫生保健成本进行了趋势3的趋势。在AIM 1到3的垂直整合护理和使用结果以检查这些贡献汇总患者结局和医疗保健成本趋势的趋势拟议项目将使用2003 - 2015年的链接医疗保险数据，并将重点介绍三个“示踪剂”条件：中风，髋部骨折和下肢关节式替代品。结果将提供有关垂直整合和旨在改善护理协调的拟议Medicare改革的潜在影响的重要证据。