PDF(Pubmed)
Abstract：
UNASSIGNED: Reduced institutional postacute care has been associated with savings in alternative payment models. However, organizations may avoid voluntary participation if participation could threaten their own revenues.
UNASSIGNED: To characterize the association between hospital-skilled nursing facility (SNF) integration and participation in Medicare\'s Bundled Payments for Care Improvement Advanced (BPCI-A) program.
UNASSIGNED: This is a cross-sectional analysis of hospital participation in BPCI-A beginning with its launch in 2018. Each SNF-integrated hospital was matched with 2 nonintegrated hospitals for each of 4 episode-specific analyses. Fifteen hospital-level variables were used for matching: beds, case mix index, days, area SNF beds, metropolitan location, ownership, region, system membership, and teaching status. Hospitals were also matched on episode-specific volume, target price, and the interaction of target price and case mix. Episode-specific logistic models were estimated regressing hospital participation on integration and the previously listed variables. The marginal effect of integration on participation was then calculated. Analysis took place from August 2022 to May 2024.
UNASSIGNED: Hospital-SNF integration, as defined by common ownership and referral patterns and identified using cost reports, Medicare claims, and Provider Enrollment, Chain, and Ownership System records. Additional sources included records of target prices and participation, the Area Health Resources File, and the Compendium of US Health Systems.
UNASSIGNED: Participation in BPCI-A.
UNASSIGNED: In total, 1524 hospitals met criteria for inclusion in the hip and femur (HFP) analysis, 1825 were included in the major joint replacement of the lower extremity (MJRLE) analysis, 2018 were included in the sepsis analysis, and 1564, were included in the stroke-specific analysis. Across episodes, 191 HFP-eligible hospitals (12.5% of HFP-eligible hospitals), 302 MJRLE-eligible hospitals (16.5%), 327 sepsis-eligible hospitals (16.2%), and 185 sepsis-eligible hospitals (11.8%) were SNF integrated. In total, 79 hospitals (5.2%) participated in the HFP episode, 128 (7.0%) participated in the MJRLE episode, 204 (10.1%) participated in the sepsis episode, and 141 (9.0%) participated in the stroke episode. Integration was associated with a 4.7-percentage point decrease (95% CI, 2.4 to 6.9 percentage points) in participation in the MJRLE episode. There was no association between integration and participation for HFP (0.5-percentage point increase in participation moving from nonintegrated to integrated; 95% CI, -2.9 to 3.8 percentage points), sepsis (1.0-percentage point increase; 95% CI, -2.2 to 4.2 percentage points), and stroke (0.3-percentage point decrease; 95% CI, -3.1 to 3.8 percentage points).
UNASSIGNED: In this cross-sectional study, there was an uneven association between hospital-SNF integration and participation in Medicare\'s BPCI-A program. Other factors may be more consistent determinants of selection into voluntary payment reform.
UNASSIGNED: To characterize the association between hospital-skilled nursing facility (SNF) integration and participation in Medicare\'s Bundled Payments for Care Improvement Advanced (BPCI-A) program.
UNASSIGNED: This is a cross-sectional analysis of hospital participation in BPCI-A beginning with its launch in 2018. Each SNF-integrated hospital was matched with 2 nonintegrated hospitals for each of 4 episode-specific analyses. Fifteen hospital-level variables were used for matching: beds, case mix index, days, area SNF beds, metropolitan location, ownership, region, system membership, and teaching status. Hospitals were also matched on episode-specific volume, target price, and the interaction of target price and case mix. Episode-specific logistic models were estimated regressing hospital participation on integration and the previously listed variables. The marginal effect of integration on participation was then calculated. Analysis took place from August 2022 to May 2024.
UNASSIGNED: Hospital-SNF integration, as defined by common ownership and referral patterns and identified using cost reports, Medicare claims, and Provider Enrollment, Chain, and Ownership System records. Additional sources included records of target prices and participation, the Area Health Resources File, and the Compendium of US Health Systems.
UNASSIGNED: Participation in BPCI-A.
UNASSIGNED: In total, 1524 hospitals met criteria for inclusion in the hip and femur (HFP) analysis, 1825 were included in the major joint replacement of the lower extremity (MJRLE) analysis, 2018 were included in the sepsis analysis, and 1564, were included in the stroke-specific analysis. Across episodes, 191 HFP-eligible hospitals (12.5% of HFP-eligible hospitals), 302 MJRLE-eligible hospitals (16.5%), 327 sepsis-eligible hospitals (16.2%), and 185 sepsis-eligible hospitals (11.8%) were SNF integrated. In total, 79 hospitals (5.2%) participated in the HFP episode, 128 (7.0%) participated in the MJRLE episode, 204 (10.1%) participated in the sepsis episode, and 141 (9.0%) participated in the stroke episode. Integration was associated with a 4.7-percentage point decrease (95% CI, 2.4 to 6.9 percentage points) in participation in the MJRLE episode. There was no association between integration and participation for HFP (0.5-percentage point increase in participation moving from nonintegrated to integrated; 95% CI, -2.9 to 3.8 percentage points), sepsis (1.0-percentage point increase; 95% CI, -2.2 to 4.2 percentage points), and stroke (0.3-percentage point decrease; 95% CI, -3.1 to 3.8 percentage points).
UNASSIGNED: In this cross-sectional study, there was an uneven association between hospital-SNF integration and participation in Medicare\'s BPCI-A program. Other factors may be more consistent determinants of selection into voluntary payment reform.
摘要：
■减少机构急性后护理与替代支付模式的节省有关。然而,如果参与可能威胁到自己的收入，组织可能会避免自愿参与。
■描述医院-专业护理机构(SNF)整合与参与Medicare的护理改善高级捆绑支付(BPCI-A)计划之间的关联。
■这是从2018年BPCI-A推出开始的医院参与的横截面分析。每个SNF整合医院与2个非整合医院进行4个特定事件分析。使用15个医院级别的变量进行匹配：床位，案例混合索引，days,区域SNF床，大都市位置,所有权,区域,系统成员,和教学地位。医院也在特定事件的音量上进行了匹配，目标价格,以及目标价格和案例组合的相互作用。估计特定事件的逻辑模型，将医院参与与整合和先前列出的变量进行回归。然后计算了一体化对参与的边际效应。分析时间为2022年8月至2024年5月。
■医院-SNF整合，由共同所有权和推荐模式定义，并使用成本报告确定，医疗保险索赔，和提供者注册，链条,和所有权系统记录。其他来源包括目标价格和参与记录，地区卫生资源档案，和美国卫生系统简编。
■参与BPCI-A
■总共，1524家医院符合纳入髋关节和股骨（HFP）分析的标准，1825例纳入下肢大关节置换术（MJRLE）分析，2018年被纳入脓毒症分析，和1564,纳入卒中特异性分析.在整个情节中，191家符合HFP资格的医院（占符合HFP资格的医院的12.5%），302家符合MJRLE标准的医院（16.5%），327家败血症合格医院（16.2%），185家符合脓毒症条件的医院(11.8%)进行了SNF整合.总的来说,79家医院（5.2%）参与了HFP事件，128（7.0%）参加了MJRLE事件，204（10.1％）参与了败血症发作，141例(9.0%)参与卒中发作.整合与参与MJRLE发作的4.7个百分点（95％CI，2.4至6.9个百分点）下降相关。HFP的融合与参与之间没有关联（从非融合到融合的参与增加0.5个百分点；95％CI，-2.9至3.8个百分点），脓毒症（增加1.0个百分点；95%CI，-2.2至4.2个百分点），和中风（下降0.3个百分点；95%CI，-3.1至3.8个百分点）。
■在这项横断面研究中，医院-SNF整合与参与Medicare的BPCI-A计划之间存在不均衡的关联.其他因素可能是选择自愿支付改革的更一致的决定因素。
■描述医院-专业护理机构(SNF)整合与参与Medicare的护理改善高级捆绑支付(BPCI-A)计划之间的关联。
■这是从2018年BPCI-A推出开始的医院参与的横截面分析。每个SNF整合医院与2个非整合医院进行4个特定事件分析。使用15个医院级别的变量进行匹配：床位，案例混合索引，days,区域SNF床，大都市位置,所有权,区域,系统成员,和教学地位。医院也在特定事件的音量上进行了匹配，目标价格,以及目标价格和案例组合的相互作用。估计特定事件的逻辑模型，将医院参与与整合和先前列出的变量进行回归。然后计算了一体化对参与的边际效应。分析时间为2022年8月至2024年5月。
■医院-SNF整合，由共同所有权和推荐模式定义，并使用成本报告确定，医疗保险索赔，和提供者注册，链条,和所有权系统记录。其他来源包括目标价格和参与记录，地区卫生资源档案，和美国卫生系统简编。
■参与BPCI-A
■总共，1524家医院符合纳入髋关节和股骨（HFP）分析的标准，1825例纳入下肢大关节置换术（MJRLE）分析，2018年被纳入脓毒症分析，和1564,纳入卒中特异性分析.在整个情节中，191家符合HFP资格的医院（占符合HFP资格的医院的12.5%），302家符合MJRLE标准的医院（16.5%），327家败血症合格医院（16.2%），185家符合脓毒症条件的医院(11.8%)进行了SNF整合.总的来说,79家医院（5.2%）参与了HFP事件，128（7.0%）参加了MJRLE事件，204（10.1％）参与了败血症发作，141例(9.0%)参与卒中发作.整合与参与MJRLE发作的4.7个百分点（95％CI，2.4至6.9个百分点）下降相关。HFP的融合与参与之间没有关联（从非融合到融合的参与增加0.5个百分点；95％CI，-2.9至3.8个百分点），脓毒症（增加1.0个百分点；95%CI，-2.2至4.2个百分点），和中风（下降0.3个百分点；95%CI，-3.1至3.8个百分点）。
■在这项横断面研究中，医院-SNF整合与参与Medicare的BPCI-A计划之间存在不均衡的关联.其他因素可能是选择自愿支付改革的更一致的决定因素。
