为调查Medicare专业护理机构(SNF)共付额政策的影响,受益期第20天的每日共付额大幅增加,关于逗留时间,患者结果,和成本。
2012年至2016年的回顾性队列研究,使用医疗保险索赔和SNF评估数据,包括针对Medicare按服务收费受益人的SNF入场券。
我们首先估计在患者受益期的第21天,Medicare的SNF共付额的变化如何影响SNF的住院时间。然后,我们使用入院时的福利日作为工具变量来估计与共付额政策相关的SNF住院时间对再入院和Medicare支付的影响。
从2012年到2016年,我们检查了291.134SNF入学情况。SNF入院的获益日较高与SNF住院时间较短密切相关。SNF住院时间缩短1天与出院后30天内(1.5个百分点;95%CI1.4-1.6,P<.001)和SNF出院后30天内(0.9个百分点;95%CI0.8-1.0)较高的再入院率相关,出院后90天的医疗保险支付总额较低(396美元;95%CI361-431,P<.001),但SNF出院后90天的付款额要高出179美元(95%CI149-210,P<.001),抵消较短指数SNF逗留的较低付款。
Medicare的SNF共付额政策与较短的住院时间和较差的患者预后相关,表明共付额政策对患者结局具有非预期的负面影响.
To investigate the impact of Medicare\'s skilled nursing facility (SNF) copayment policy, with a large increase in the daily copayment rate on the 20th day of a benefit period, on length of stay, patient outcomes, and costs.
Retrospective cohort study from 2012 to 2016 using Medicare claims and SNF assessment data, including SNF admissions for Medicare fee-for-service beneficiaries.
We first estimate how changes in Medicare\'s SNF copayment on the 21st day of a patient\'s benefit period affect length of SNF stay. We then use benefit day on admission as an instrumental variable to estimate the impact of SNF length of stay related to the copayment policy on readmission and Medicare payment.
From 2012 to 2016, we examined 291 134 SNF admissions. Higher benefit day on SNF admission was strongly associated with shorter SNF stays. A 1-day shorter SNF stay was associated with higher readmission rate within 30 days of hospital discharge (1.5 percentage points; 95% CI 1.4-1.6, P < .001) and within 30 days of SNF discharge (0.9 percentage points; 95% CI 0.8-1.0), lower total Medicare payment for the 90-day episode after hospital discharge ($396; 95% CI 361-431, P < .001), but $179 higher payment for the 90 days after SNF discharge (95% CI 149-210, P < .001), offsetting the lower payment for the shorter index SNF stay.
Medicare\'s SNF copayment policy is associated with shorter lengths of stay and worse patient outcomes, suggesting the copayment policy has unintended and negative effects on patient outcomes.