Higher Primary Care Reimbursements and the Quality of Care for Dually-Eligible Patients with Alzheimer's Disease and Related Dementias in Skilled Nursing Facilities

熟练护理机构中具有双重资格的阿尔茨海默病和相关痴呆症患者的初级保健报销更高，护理质量更高

• 批准号: 10591503
• 负责人: Hye-Young Jung
• 金额: $ 17.21万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10591503
• 关键词: Address; Adverse event; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Area; Caring; Characteristics; Coinsurance; Disparity; Elderly; Ensure; Etiology; Evaluation; Fee-for-Service Plans; Fees; Health Expenditures; Health care facility; Home; Hospitalization; Institution; Institutionalization; Lead; Length of Stay; Measures; Medicaid; Medicare; Medicare Part B; Natural experiment; Nature; Outpatients; Patient Admission; Patient Care; Patient-Focused Outcomes; Patients; Physicians; Policies; Population; Preventive care; Primary Care; Provider; Quality of Care; Quasi-experiment; Race; Research; Research Design; Research Priority; Sampling; Services; Skilled Nursing Facilities; Source; Variant; Visit; adverse outcome; beneficiary; care costs; care fragmentation; cost; disparity reduction; dual eligible; experience; expiration; functional improvement; hospital readmission; improved; mortality; primary care services; programs; racial disparity; racial minority; readmission rates; service coordination

PROJECT SUMMARY/ABSTRACT Medicare fee-for-service beneficiaries experience 2.4 million skilled nursing facility (SNF) stays annually. Nearly 1.5 million of these stays are for patients with Alzheimer’s disease or related dementias (ADRD) and over 1 million are for dually-eligible beneficiaries. Hospitalized patients with ADRD are four times more likely to be discharged to a skilled nursing facility (SNF) compared to patients without ADRD. Patients with ADRD have longer SNF length of stay and re-hospitalization rates that are nearly 50% higher than for patients without ADRD. Medicare spends $6,547 per beneficiary annually on SNF stays among those with ADRD, compared to $448 among beneficiaries without ADRD. Dual-eligibles who receive care in SNFs are more likely to experience adverse outcomes, including re-hospitalization or becoming permanently institutionalized, compared to non- duals. Many of the adverse events experienced by dual-eligibles in SNFs are thought to arise from fragmented care that is poorly coordinated and are potentially avoidable with proper preventive care and improved coordination of services. The Medicaid Primary Care Fee Bump provides a natural experiment to examine the impact of higher physician reimbursement on the quality of care for dually-eligible SNF patients with ADRD. Over a two-year period (2013-2014), the initiative required states’ Medicaid programs to reimburse providers the same rates as Medicare for primary care services for all Medicaid patients. For dual-eligibles, the fee bump required Medicaid programs to reimburse providers the full 20% Medicare coinsurance for primary care services, which included evaluation and management services provided in SNFs. Prior to the fee bump and following its expiration, states covered 0 to 20 percentage points of Medicare Part B coinsurance. Using a national sample of all dually-eligible SNF patients with ADRD over an eight-year period (2012-2019), this project will take advantage of the natural experiment created by the Medicaid Primary Care Fee Bump to identify the impact of higher reimbursement for primary care services on the quality and cost of care for these patients. This will be done using two sources of variation: (1) the timing of both the implementation and termination of the fee bump and (2) variation in the states reimbursing physicians the full 20% Medicare coinsurance for dual-eligibles before and after the fee bump. The quasi-experimental nature of the research design will allow estimation strongly indicative of causation and our national sample of all dually-eligible SNF patients with ADRD will help ensure that the results are generalizable. The project will provide highly valuable evidence indicating whether increased reimbursement for primary care services in SNFs improves the quality and/or lowers the cost of care for dually- eligible patients with ADRD. This issue has immediate policy relevance as 31 states did not maintain higher reimbursement rates for these services after the fee bump expired at the end of 2014.

项目摘要/摘要 Medicare费用为服务受益人经历了240万熟练的护士设施（SNF）每年保持。几乎 这些住宿中的150万适用于阿尔茨海默氏病或​​相关痴呆症（ADRD）的患者，超过1个 百万用于双重资格的受益人。住院的ADRD患者的可能性是 与没有ADRD的患者相比，已出院到熟练的护士设施（SNF）。 ADRD患者 较长的SNF住院时间和重新住院率几乎比没有ADRD的患者高出50％。 Medicare每年在ADRD的人群中每年花费$ 6,547，而448美元 在没有ADRD的受益人中。在SNF中获得护理的双重划定更有可能体验 与非 - 双人。 snf中双重划分经历的许多不良事件都被认为是由于零散而产生的 协调不佳的护理，可以通过适当的预防性护理来避免并有所改善 服务协调。医疗补助初级保健费用提供了自然实验，以检查 较高的物理报销对ADRD的多数合格SNF患者的护理质量的影响。超过 该计划为期两年（2013-2014），要求各州的医疗补助计划来偿还提供商相同 作为所有医疗补助患者的初级保健服务的医疗保险。对于双重划分，需要费用颠簸 医疗补助计划，以偿还提供商的全部20％的医疗保险共同保健服务，这是 包括SNF中提供的评估和管理服务。在收费颠簸之前并遵循 到期，各州涵盖了Medicare B部分共同保险的0至20个百分点。使用国家样本 在八年（2012-2019）中所有双重资格的SNF患者中，该项目将采用 医疗补助初级保健费用降低创建的自然实验的优势，以确定 在这些患者的护理质量和护理成本方面，高额报销。这将是 使用两个变化来源完成：（1）实施和终止费用的时间 （2）各州的变化向医生偿还了全部20％的Medicare共同保险 收费颠簸之后。研究设计的准实验性质将允许强烈估计 指示因果关系和我们的所有双重资格SNF患者的国家样本，将有助于确保 结果是可以推广的。该项目将提供高度宝贵的证据，表明是否增加 SNF中的初级保健服务的报销可改善双重质量和/或降低护理成本 - 合格的ADRD患者。这个问题具有直接的政策相关性，因为31个州没有保持更高 收费率在2014年底到期后，这些服务的报销率。