背景:不断上涨的医疗保健费用和随之而来的医疗保险报销费用的增加导致了多年来的许多支付改革。1983年,医院实施了前瞻性支付系统(PPS),这激励了医院购买熟练的护理设施(SNF)或利用其过剩的能力在医院内建立一个护理设施。随着1998年向SNF申请PPS报销,先前对医院拥有SNF的金钱激励措施消失了。然而,尽管数量减少了,许多医院继续经营以医院为基础的专业护理设施(HBSNFs).
目的:本研究使用组织的种群生态学框架研究了与HBSNFs生存相关的组织和市场层面因素。
方法:使用美国医院协会的调查数据,所有1998年开放HBSNF的美国急性护理医院的事件历史被绘制,以检查医院是否在22年期间(1998-2020)关闭其HBSNF.主要自变量包括医院规模,所有权,总保证金,市场竞争,和医疗保险优势渗透。自变量和控制变量滞后1年。进行Cox回归以估计捕获HBSNF关闭风险的风险比。
结果:结果表明,HBSNFs位于大型,非营利性医院和在竞争较弱的市场中运营的医院生存的可能性更大。
结论:小型的HBSNF管理员,营利性医院和在竞争激烈的市场中运营的医院可以利用这项研究的结果,明智地将闲置资源分配给他们的HBSNF,以保持开放,因为目前监管机构强调护理的连续性。
Rising health care costs and consequent increases in Medicare reimbursements have led to many payment reforms over the years. Implementation of the prospective payment system (PPS) for hospitals in 1983 incentivized hospitals to either purchase skilled nursing facilities (SNFs) or utilize their excess capacity to establish one within the hospital. With PPS reimbursement being applied to SNFs in 1998, prior monetary incentives for hospitals to own an SNF disappeared. However, despite the reduction in numbers, many hospitals continued to operate their hospital-based skilled nursing facilities (HBSNFs).
This study examines the organizational and market-level factors associated with the survival of HBSNFs using the population ecology of organizations framework.
Using American Hospital Association survey data, event histories of all U.S. acute care hospitals with an open HBSNF in 1998 were plotted to examine if a hospital closed its HBSNF during a 22-year period (1998-2020). The primary independent variables included hospital size, ownership, total margin, market competition, and Medicare Advantage penetration. The independent and control variables were lagged by 1 year. Cox regressions were conducted to estimate the hazard ratios capturing the risk of HBSNF closure.
The results showed that HBSNFs located in large, not-for-profit hospitals and those operating in less competitive markets had greater odds of surviving.
The HBSNF administrators of small, for-profit hospitals and those operating in highly competitive markets could utilize the findings of this study to judiciously allocate slack resources to their HBSNFs to keep those open given the current emphasis on continuity of care by regulatory bodies.