目的:描述和比较使用住院康复设施(IRF)和长期护理医院(LTCH)的索赔和成本报告数据估算住院级Medicare设施(A部分)成本的三种方法,两家医院的急性后护理提供者。
方法:我们使用不同的方法计算了住宿级别的设施成本。方法1使用了每天的常规成本和辅助成本费用比率。方法2使用常规和辅助成本-费用比(仅限独立IRF和LTCH)。方法3使用提供商特定文件中特定于设施的运营成本-收费比率。对于每种方法,我们将成本与索赔和设施水平的付款和费用进行了比较,并检查了设施利润率。
方法:数据来自1,619个提供商,包括266个独立的IRF,909个IRF单位,和444LTCH。
方法:分析包括2014年的239,284项索赔,其中86,118项索赔来自独立IRF,92,799项索赔来自IRF单位,60,367项索赔来自LTCHs。
方法:不适用主要结果指标(S):2014年的成本和付款美元结果:对于独立IRF,平均设施停留水平成本的计算为13,610美元(方法1),$13,575(方法2)和$13,783(方法3)。对于IRF单位,平均设施停留水平费用为17,385美元(方法1)和19,093美元(方法3)。对于LTCH,设施停留水平的平均费用为36,362美元(方法1),$36,407(方法2),37056美元(方法3)。
结论:这三种方法导致设施平均停留水平成本的差异很小。使用设施级成本收费比(方法3)是资源密集程度最低的方法。虽然资源更加密集,使用每日常规成本和辅助成本-收费比(方法1)进行成本计算,可以根据服务使用组合的差异区分不同患者的成本.随着政策制定者考虑急性护理后支付改革,成本,而不是收费或付款数据,需要计算和比较的方法的结果。
OBJECTIVE: To describe and compare three methods for estimating stay-level Medicare facility (Part A) costs using claims and cost-report data for inpatient rehabilitation facilities (IRFs) and long-term care hospitals (LTCHs), the two hospital-based post-acute care providers.
METHODS: We calculated stay-level facility costs using different methods. Method 1 used routine costs per day and ancillary cost-to-charge ratios. Method 2 used routine and ancillary cost-to-charge ratios (freestanding IRFs and LTCHs only). Method 3 used facility-specific operating cost-to-charge ratios from the Provider Specific File. For each method, we compared the costs to payments and charges at the claim and facility levels and examined facility margins.
METHODS: Data are from 1,619 providers, including 266 freestanding IRFs, 909 IRF units, and 444 LTCHs.
METHODS: The analyses included 239,284 claims from 2014, of which 86,118 claims were from freestanding IRFs, 92,799 claims were from IRF units, and 60,367 claims were from LTCHs.
METHODS: Not applicable MAIN OUTCOME MEASURE(S): Costs and payments in 2014 United States Dollars RESULTS: For freestanding IRFs, the mean facility stay-level costs were calculated to be $13,610 (Method 1), $13,575 (Method 2) and $13,783 (Method 3). For IRF units, the mean facility stay-level costs were $17,385 (Method 1) and $19,093 (Method 3). For LTCHs, the mean facility stay-level costs were $36,362 (Method 1), $36,407 (Method 2), $37,056 (Method 3).
CONCLUSIONS: The three methods resulted in small differences in facility mean stay-level costs. Using the facility-level cost-to-charge ratio (Method 3) is the least resource intensive method. While more resource intensive, using routine cost per day and ancillary cost-to-to-charge ratios (Method 1) for cost calculations allows differentiation in costs across patients based on differences in the mix of service use. As policymakers consider post-acute care payment reforms, cost, rather than charge or payment data, need to be calculated and the results of the methods compared.