与医疗保险支付改革和 COVID-19 大流行相关的专业护理和家庭医疗入院人数变化。

IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Journal of the American Geriatrics Society Pub Date : 2024-12-16 DOI:10.1111/jgs.19322
Rachel A. Prusynski DPT, PhD, Natalie E. Leland PhD, OTR/L, Andrew Humbert PhD, Arati Dahal PhD, Cait Brown MA, CCC-SLP, Harsha Amaravadi MPH, Debra Saliba MD, MPH, Tracy M. Mroz PhD, OTR/L
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引用次数: 0

摘要

背景:就在医疗保险实施急性期后护理支付改革后不久,COVID-19大流行开始了,但人们对这些改革和大流行如何影响最常见的急性期后护理机构--专业护理机构(SNF)和家庭保健机构(HHA)--医疗保险付费服务全部人群的入院情况知之甚少:我们使用 100% 的联邦医疗保险付费服务数据,对 2018 年至 2021 年期间所有活着出院的成年受益人的 31,730,994 次住院进行了调整后的间断时间序列分析,以研究与改革前和前 COVID(基线)趋势相比,支付改革和大流行是否与入住 SNF 和 HHA 的差异有关:基线时,平均 18.0% 的住院受益人入住 SNF,14.8% 入住 HHA。虽然 2019 年 10 月实施的 SNF 支付改革立即减少了 SNF 住院人数,但积极的时间趋势逆转了住院人数的减少。与基线相比,2020 年 1 月实施的 HHA 支付改革导致 HHA 入院人数增加。COVID 后,SNF 的入院率下降至出院患者的 15.5%,而 HHA 的入院率上升至 19.2%:结论:SNF 和 HHA 支付改革与各自机构入院人数的小幅增加有关,这表明医疗保险改革并未对入院人数产生负面影响。然而,COVID-19 大流行大大加速了 SNF 住院人数减少和 HHA 住院人数增加的基线趋势。结果凸显了对这些机构需求的变化,在制定政策和研究对特定患者群体的影响时必须认识到这一点。
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Changes in skilled nursing and home health admissions associated with Medicare payment reforms and the COVID-19 pandemic

Background

Shortly after Medicare implemented post-acute care payment reforms, the COVID-19 pandemic began, but little is known about how these reforms and the pandemic impacted admissions to the most common post-acute settings—skilled nursing facilities (SNF) and home health agencies (HHAs)—for the full Medicare fee-for-service population.

Methods

Using 100% of Medicare fee-for-service data, we conducted adjusted interrupted time series analyses of 31,730,994 hospital stays of all adult beneficiaries discharged alive from the hospital between 2018 and 2021 to examine whether payment reforms and the pandemic were associated with differences in admissions to SNFs and HHAs compared to pre-reform and pre-COVID (baseline) trends.

Results

At baseline, an average 18.0% of hospitalized beneficiaries were admitted to SNFs and 14.8% to HHAs. While SNF payment reform in October 2019 was associated with an immediate reduction in SNF admissions, a positive temporal trend reversed this decrease in admissions. HHA payment reform implemented in January 2020 was associated with increased HHA admissions compared to baseline. Post-COVID, admissions to SNF declined to 15.5% of patients being discharged from hospitals and HHA admissions increased to 19.2%.

Conclusions

SNF and HHA payment reforms were associated with small increases in admissions to their respective settings, suggesting that Medicare reforms did not negatively impact access. However, the baseline trends of decreasing admissions to SNF and increasing HHA admissions were greatly accelerated by the COVID-19 pandemic. Results highlight changes in the demand for these settings, which must be recognized in policy efforts and research examining impacts on specific patient populations.

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来源期刊
CiteScore
10.00
自引率
6.30%
发文量
504
审稿时长
3-6 weeks
期刊介绍: Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.
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