2020 年熟练家庭医疗保健支付改革对痴呆症患者的影响。
Implications of 2020 Skilled Home Healthcare Payment Reform for Persons with Dementia.
机构信息
Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Division of Geriatric Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
出版信息
J Am Geriatr Soc. 2020 Oct;68(10):2303-2309. doi: 10.1111/jgs.16654. Epub 2020 Jun 20.
BACKGROUND/OBJECTIVES: The Medicare home health benefit provides episodic skilled home-based clinical care to the growing population of community-dwelling persons with dementia. As of January 1, 2020, home health payment changed: episodes shortened from 60 to 30 days, and episodes initiated in the community are now reimbursed at lower rates than episodes following institutional stays. We aim to assess the potential impact of these policy changes on this population.
DESIGN/SETTING: Cross-sectional study using the Medicare claims-linked National Health and Aging Trends Study (NHATS).
PARTICIPANTS
A total of 1,867 NHATS respondents who received home health between 2011 and 2017.
MEASUREMENTS
Dementia was defined through both self-report and a validated cognitive assessment through NHATS. We described the demographic, socioeconomic, and health characteristics of older adults with dementia receiving home health compared with those without dementia. We then assessed the association of dementia with both receiving community-initiated home health (vs postinstitutional) and visit timing during the home health episode.
RESULTS
Over a follow-up period of just over 4 years, 50.2% of persons with dementia used home health compared with 15.3% of persons without dementia. Most home health provided to persons with dementia was initiated in the community (61%), compared with 37% of episodes provided to persons without dementia. Persons with dementia were more likely to receive care in days 31 to 60 of the episode compared with those without dementia.
CONCLUSIONS
Shortening episodes and reimbursing community-initiated episodes at lower rates may disproportionately impact the highly vulnerable population of older adults with dementia, who receive more community-initiated care over longer time periods. Our work highlights the need to better understand the unique role of home health in meeting gaps in both acute- and long-term care systems for older adults with dementia. J Am Geriatr Soc 68:2303-2309, 2020.
背景/目的：医疗保险家庭保健福利为居住在社区的不断增加的痴呆症患者提供间歇性的熟练家庭临床护理。自 2020 年 1 月 1 日起，家庭保健支付发生变化：每个阶段从 60 天缩短至 30 天，并且现在社区发起的阶段比机构住院后的阶段报销率更低。我们旨在评估这些政策变化对这一人群的潜在影响。
设计/设置：使用医疗保险索赔链接的国家健康与老龄化趋势研究（NHATS）进行的横断面研究。
参与者
总共 1867 名 NHATS 受访者，他们在 2011 年至 2017 年期间接受了家庭保健。
测量
通过 NHATS 中的自我报告和经过验证的认知评估来定义痴呆症。我们描述了与没有痴呆症的老年人相比，接受家庭保健的痴呆症老年人的人口统计学、社会经济和健康特征。然后，我们评估了痴呆症与社区发起的家庭保健（与机构后）和家庭保健阶段期间的就诊时间之间的关联。
结果
在不到 4 年的随访期间，50.2%的痴呆症患者使用了家庭保健，而 15.3%的没有痴呆症的患者使用了家庭保健。向痴呆症患者提供的大部分家庭保健是在社区中启动的（61%），而向没有痴呆症的患者提供的则为 37%。与没有痴呆症的患者相比，痴呆症患者更有可能在阶段的第 31 天至 60 天接受护理。
结论
缩短阶段和以较低的费率报销社区发起的阶段可能会不成比例地影响高度脆弱的老年痴呆症患者群体，他们在更长的时间内接受更多的社区发起的护理。我们的工作强调了需要更好地了解家庭保健在满足痴呆症老年人的急性和长期护理系统中的差距方面的独特作用。美国老年学会杂志 68：2303-2309，2020。
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