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The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs.
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- معلومة اضافية
- المصدر:
Publisher: Blackwell Country of Publication: United States NLM ID: 0053006 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1475-6773 (Electronic) Linking ISSN: 00179124 NLM ISO Abbreviation: Health Serv Res Subsets: MEDLINE
- بيانات النشر:
Publication: Malden, MA : Blackwell
Original Publication: Chicago, Hospital Research and Educational Trust.
- الموضوع:
- نبذة مختصرة :
Objective: 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.
Data Sources and Study Setting: Retrospective cohort study from 2012 to 2016 using Medicare claims and SNF assessment data, including SNF admissions for Medicare fee-for-service beneficiaries.
Study Design: 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.
Principal Findings: 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.
Conclusions: 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.
(© 2019 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust.)
- References:
JAMA Intern Med. 2019 May 1;179(5):617-623. (PMID: 30855652)
JAMA Intern Med. 2017 Feb 1;177(2):214-222. (PMID: 28055062)
JAMA. 2016 Sep 27;316(12):1267-78. (PMID: 27653006)
Health Serv Res. 2019 Dec;54(6):1184-1192. (PMID: 31657002)
JAMA. 2018 Apr 17;319(15):1616-1617. (PMID: 29677292)
Health Serv Res. 2019 Apr;54(2):324-326. (PMID: 30848490)
N Engl J Med. 2019 Jan 17;380(3):252-262. (PMID: 30601709)
JAMA Intern Med. 2017 Apr 1;177(4):518-526. (PMID: 28192556)
JAMA Intern Med. 2019 May 28;:. (PMID: 31135825)
PLoS Med. 2018 Jun 26;15(6):e1002592. (PMID: 29944655)
N Engl J Med. 2013 Apr 18;368(16):1465-8. (PMID: 23520983)
- Grant Information:
T32 AG051090 United States AG NIA NIH HHS; R01 HS024266 United States HS AHRQ HHS; K24-AG047908 United States AG NIA NIH HHS; K24 AG047908 United States AG NIA NIH HHS
- Contributed Indexing:
Keywords: Medicare payment; postacute care; skilled nursing facility
- الموضوع:
Date Created: 20191029 Date Completed: 20200127 Latest Revision: 20240501
- الموضوع:
20240501
- الرقم المعرف:
PMC6863243
- الرقم المعرف:
10.1111/1475-6773.13227
- الرقم المعرف:
31657002
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