Competition Among Post Acute Care Providers

急症后护理提供者之间的竞争

• 批准号: 7786443
• 负责人: Neeraj Sood
• 金额: $ 49.96万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7786443
• 关键词: Competition; Among; Post; Acute; Care

DESCRIPTION (provided by the applicant): Each year, millions of Medicare beneficiaries are discharged from acute care hospitals into post-acute care settings, including inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and homes with services from home health agencies (HHAs). Expenditures for post-acute care (PAC) now consume 15% of Medicare's fee-for-service spending; they have grown steadily since 2000, despite efforts to contain PAC costs. The President's budget blueprint released on February 26th of this year envisions further changes to Medicare's PAC payment policies, including bundled payments for episodes of care that will include hospital stays, post-acute care, and readmissions. Yet, little is known about the value of PAC care, much less the effects of existing payment arrangements on total Medicare costs, the clinical outcomes of PAC users, and the structure of markets for PAC. The overarching goal of the proposed project is to enhance our understanding of the causes and effects of competition in PAC markets, with a particular focus on how changes in PAC payment policies have both influenced competition in these markets and modified the effects of competition on resource use and clinical outcomes. It will examine Medicare patients with three "tracer" conditions: stroke, hip fracture, and lower extremity joint replacement (LEJR). Specifically, our aims are to: 1. Examine the effects of competition on resource use and clinical outcomes for PAC episodes among patients discharged from an acute care hospital after a stroke, fracture, or LEJR, and how these effects are mitigated or enhanced by payment policies; 2. Assess how the effects of competition on resource use and clinical outcomes for PAC episodes differ depending on whether patients discharged from an acute care hospital with one of the three study conditions initially go to an IRF, a SNF, or home with or without home health care; 3. Describe the variation across geographic market areas and trends over time in PAC competition, and assess the factors that influence these variations and trends, especially changes in PAC payment policies. The proposed project will use linked Medicare administrative data for 1996-2008, as well as state-of-the-art analytic methods to achieve the project's objectives. Given the paucity of research in the fields of PAC and of health care market structure outside the hospital sector, the project will constitute a major and important step toward understanding and improving the value of PAC and care systems more generally.

描述（由申请人提供）：每年，数百万的医疗保险受益人从急诊医院出院到急性后护理机构，包括住院治疗设施（IRFS），熟练的护理设施（SNFS），以及与家庭健康机构（HHAS）的服务。急性后护理（PAC）的支出现在消耗了Medicare支付费用的15％；自2000年以来，尽管努力控制PAC成本，但它们一直稳步增长。总统今年2月26日发布的预算蓝图设想了Medicare PAC支付政策的进一步变化，包括捆绑的护理付款，其中包括医院住院，急性后护理和再入院。然而，对PAC护理的价值知之甚少，更不用说现有付款安排对Medicare总成本，PAC用户的临床结果以及PAC市场结构的影响。拟议项目的总体目标是增强我们对PAC市场竞争的原因和影响的理解，特别关注PAC支付政策的变化如何影响这些市场的竞争，并改变了竞争对资源使用和临床结果的影响。它将检查患有三种“示踪剂”疾病的Medicare患者：中风，髋部骨折和下肢置换术（LEJR）。具体而言，我们的目的是：1。检查竞争对资源使用和临床结果对PAC发作的影响，在中风，断裂或LEJR后从急诊医院出院的患者中，以及如何通过支付政策来减轻或增强这些影响； 2.评估竞争对PAC发作的资源使用和临床结果的影响如何不同，具体取决于从急诊医院出院的患者，三个研究条件之一最初是进入IRF，SNF或拥有家庭医疗保健的家中的三个研究条件之一； 3.描述PAC竞争中地理市场领域和趋势的变化，并评估影响这些变化和趋势的因素，尤其是PAC支付政策的变化。拟议的项目将使用1996 - 2008年的链接医疗保险管理数据以及最先进的分析方法来实现该项目的目标。鉴于医院部门以外的PAC领域和医疗保健市场结构的研究很少，该项目将构成更广泛地理解和改善PAC和护理系统价值的重要而重要的一步。