参与医疗保险捆绑支付改善护理计划的熟练护理设施：一项回顾性研究。

Skilled Nursing Facility Participation in Medicare's Bundled Payments for Care Improvement Initiative: A Retrospective Study.

机构信息

Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN.

David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.

出版信息

Arch Phys Med Rehabil. 2019 Feb;100(2):307-314. doi: 10.1016/j.apmr.2018.08.186. Epub 2018 Oct 4.

DOI:10.1016/j.apmr.2018.08.186

PMID:30291827

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6348124/

Abstract

OBJECTIVE

To investigate differences in facility characteristics, patient characteristics, and outcomes between skilled nursing facilities (SNFs) that participated in Medicare's voluntary Bundled Payments for Care Improvement (BPCI) initiative and nonparticipants, prior to BPCI.

DESIGN

Retrospective, cross-sectional comparison of BPCI participants and nonparticipants.

SETTING

SNFs.

PARTICIPANTS

All Medicare-certified SNFs (N=15,172) and their 2011-2012 episodes of care for chronic obstructive pulmonary disease, congestive heart failure, femur and hip/pelvis fracture, hip and femur procedures, lower extremity joint replacement, and pneumonia (N=873,739).

INTERVENTIONS

Participation in a bundled payment program that included taking financial responsibility for care within a 90-day episode.

MAIN OUTCOME MEASURES

This study investigates the characteristics of bundled payment participants and their patient characteristics and outcomes relative to nonparticipants prior to BPCI, to understand the implications of a broader implementation of bundled payments.

RESULTS

SNFs participating in BPCI were more likely to be in urban areas (80.8%-98.4% vs 69.5%) and belong to a chain or system (73.8%-85.5% vs 55%), and were less likely to be located in the south (13.1%-20.2% vs 35.4%). Quality performance was similar or higher in most cases for SNFs participating in BPCI relative to nonparticipants. In addition, BPCI participants admitted higher socioeconomic status patients with similar clinical characteristics. Initial SNF length of stay was shorter and hospital readmission rates were lower for BPCI patients compared to nonparticipant patients.

CONCLUSIONS

We found that SNFs participating in the second financial risk-bearing phase of BPCI represented a diversity of SNF types, regions, and levels of quality and the results may provide insight into a broader adoption of bundled payment for postacute providers.

摘要

目的

在 Bundled Payments for Care Improvement（BPCI）计划之前，调查参与和不参与 Medicare 自愿捆绑支付改善计划（BPCI）的熟练护理设施（SNF）在设施特征、患者特征和结果方面的差异。

设计

对 BPCI 参与者和非参与者进行回顾性、横断面比较。

设置

SNF。

参与者

所有 Medicare 认证的 SNF（N=15,172）及其 2011-2012 年慢性阻塞性肺疾病、充血性心力衰竭、股骨和髋/骨盆骨折、髋关节和股骨手术、下肢关节置换和肺炎的护理期（N=873,739）。

干预措施

参与一项捆绑支付计划，该计划包括在 90 天护理期内承担护理的财务责任。

主要观察指标

本研究调查了 BPCI 参与者的特征及其患者特征和结果，与 BPCI 之前的非参与者进行比较，以了解更广泛实施捆绑支付的影响。

结果

参与 BPCI 的 SNF 更有可能位于城市地区（80.8%-98.4%比 69.5%）和属于连锁或系统（73.8%-85.5%比 55%），而位于南部的可能性较小（13.1%-20.2%比 35.4%）。在大多数情况下，参与 BPCI 的 SNF 的质量表现与非参与者相似或更高。此外，BPCI 参与者收治的社会经济地位较高的患者具有相似的临床特征。与非参与者患者相比，BPCI 患者的初始 SNF 住院时间更短，医院再入院率更低。