医疗保险急性后护理事件与支付捆绑
Medicare post-acute care episodes and payment bundling.
作者信息
Morley Melissa, Bogasky Susan, Gage Barbara, Flood Shannon, Ingber Melvin J
机构信息
RTI International.
Department of Health and Human Services-Office of the Assistant Secretary for Planning and Evaluation.
出版信息
Medicare Medicaid Res Rev. 2014 Jan 24;4(1). doi: 10.5600/mmrr.004.01.b02. eCollection 2014.
BACKGROUND
The purpose of this paper is to examine service use in an episode of acute and post-acute care (PAC) under alternative episode definitions and to look at geographic differences in episode payments.
DATA AND METHODS
The data source for these analyses was a Medicare claims file for 30 percent of beneficiaries with an acute hospital initiated episode in 2008 (N = 1,705,794, of which 38.7 percent went on to use PAC). Fixed length episodes of 30, 60, and 90 days were examined. Analyses examined differences in definitions allowing any claim within the fixed length period to be part of the episode versus prorating a claim extending past the episode endpoint. Readmissions were also examined as an episode endpoint. Payments were standardized to allow for comparison of episode payments per acute hospital discharge or PAC user across states.
RESULTS
The results of these analyses provide information on the composition of service use under different episode definitions and highlight considerations for providers and payers testing different alternatives for bundled payment.
背景
本文旨在研究在不同的急性和急性后护理（PAC）发作定义下的服务使用情况，并探讨发作支付的地理差异。
数据与方法
这些分析的数据来源是2008年30%急性医院启动发作的医疗保险索赔文件（N = 1,705,794，其中38.7%继续使用PAC）。研究了30天、60天和90天的固定时长发作。分析考察了不同定义之间的差异，一种定义允许固定时长内的任何索赔成为发作的一部分，另一种定义则按比例计算超出发作终点的索赔。再入院情况也作为发作终点进行了研究。支付进行了标准化处理，以便比较各州急性医院出院或PAC使用者的发作支付情况。
结果
这些分析结果提供了不同发作定义下服务使用构成的信息，并突出了提供者和支付者在测试捆绑支付的不同替代方案时应考虑的因素。
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