Departments of Internal Medicine, Dallas, Texas.
Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
J Am Geriatr Soc. 2018 Nov;66(11):2104-2111. doi: 10.1111/jgs.15539. Epub 2018 Oct 3.
To assess the projected effect of the Centers for Medicare and Medicaid Services new site-neutral payment policy, which aims to decrease unnecessary long-term acute care hospital (LTACH) admissions by reducing reimbursements for less-ill individuals by 2020.
Observational.
National 5% Medicare data (2011-12).
We examined the proportion of site-neutral LTACH admissions. Regional LTACH market supply was defined as LTACH beds per 100,000 residents, categorized according to tertile. We conducted a hospital-level analysis to compare the projected effect of site-neutral payment on "propensity score" matched high- and low-LTACH-use hospitals.
Forty-one percent of LTACH admissions would be subjected to site-neutral payment. The proportion of site-neutral admissions was large, varied considerably according to LTACH (median 40%, interquartile range 22-60%), and was only modestly greater with greater market supply (Pearson correlation coefficient=0.23, p<.001; coefficient of determination=0.10). The site-neutral payment policy would affect 47% of admissions from the highest-supply regions, versus 30% from the lowest-supply regions (p<.001); and 43% from high-use hospitals versus 36% from propensity score-matched low-use hospitals (p<.001).
A considerable proportion of LTACH admissions will be subjected to lower site-neutral payments. Although the policy will disproportionately affect high-use regions and hospitals, it will also affect nearly one-third of the current LTACH population from low-use hospitals and regions. As such, the site-neutral payment policy may limit LTACH access in existing LTAC-scarce markets, with potential adverse implications for recovery of hospitalized older adults. J Am Geriatr Soc 66:2104-2111, 2018.
评估医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）新的基于地点的支付政策的预计效果，该政策旨在通过降低对轻症患者的报销，减少不必要的长期急性护理医院（LTACH）入院人数，目标是到 2020 年减少 20%。
观察性研究。
全国 5%的 Medicare 数据（2011-12 年）。
我们检查了基于地点的 LTACH 入院比例。区域 LTACH 市场供应定义为每 10 万居民的 LTACH 床位数量，按三分位分类。我们进行了医院层面的分析，以比较基于地点的支付对“倾向评分”匹配的高和低 LTACH 使用医院的预计影响。
41%的 LTACH 入院将受到基于地点的支付。基于地点的入院比例很大，根据 LTACH 的不同，差异很大（中位数 40%，四分位间距 22-60%），并且与更大的市场供应仅有适度的相关性（皮尔逊相关系数=0.23，p<.001；决定系数=0.10）。基于地点的支付政策将影响来自供应最高地区的 47%的入院，而来自供应最低地区的入院比例为 30%（p<.001）；来自高使用率医院的入院比例为 43%，而与倾向评分匹配的低使用率医院的入院比例为 36%（p<.001）。
相当一部分 LTACH 入院将受到较低的基于地点的支付。虽然该政策将不成比例地影响高使用率的地区和医院，但它也将影响近三分之一来自低使用率医院和地区的现有 LTACH 人群。因此，基于地点的支付政策可能会限制现有 LTACH 稀缺市场的 LTACH 获得，对住院老年患者的康复产生潜在的不利影响。美国老年学会杂志 66：2104-2111，2018 年。
