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1.
J Health Econ ; 61: 244-258, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29428772

RESUMEN

In this paper we examine empirically the effect of integration on Medicare payment and rehospitalization. We use 2005-2013 data on Medicare beneficiaries receiving post-acute care (PAC) in the U.S. to examine integration between hospitals and the two most common post-acute care settings: skilled nursing facilities (SNFs) and home health agencies (HHA), using two measures of integration-formal vertical integration and informal integration representing preferential relationships between providers without formal relationships. Our identification strategy is twofold. First, we use longitudinal models with a fixed effect for each hospital-PAC pair in a market to test how changes in integration impact patient outcomes. Second, we use an instrumental variable approach to account for patient selection into integrated providers. We find that vertical integration between hospitals and SNFs increases Medicare payments and reduces rehospitalization rates. However, vertical integration between hospitals and HHAs has little effect, nor does informal integration between hospitals and either PAC setting.


Asunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Medicare/organización & administración , Atención Subaguda/organización & administración , Anciano , Anciano de 80 o más Años , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/métodos , Femenino , Agencias de Atención a Domicilio/economía , Agencias de Atención a Domicilio/organización & administración , Administración Hospitalaria/economía , Administración Hospitalaria/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Medicare/economía , Medicare/estadística & datos numéricos , Modelos Estadísticos , Readmisión del Paciente/estadística & datos numéricos , Instituciones de Cuidados Especializados de Enfermería/economía , Instituciones de Cuidados Especializados de Enfermería/organización & administración , Atención Subaguda/economía , Resultado del Tratamiento , Estados Unidos
2.
J Arthroplasty ; 32(10): 2969-2973, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-28601245

RESUMEN

BACKGROUND: Total joint arthroplasty (TJA) accounts for more Medicare expenditure than any other inpatient procedure. The Comprehensive Care for Joint Replacement model was introduced to decrease cost and improve quality in TJA. The largest portion of episode-of-care costs occurs after discharge. This study sought to quantify the cost variation of primary total hip arthroplasty (THA) according to discharge disposition. METHODS: The Medicare and Humana claims databases were used to extract charges and reimbursements to compare day-of-surgery and 91-day postoperative costs simulating episode-of-care reimbursements. Of the patients who underwent primary THA, 257,120 were identified (204,912 from Medicare and 52,208 from Humana). Patients were stratified by discharge disposition: home with home health, skilled nursing facility, or inpatient rehabilitation facility. RESULTS: There is a significant difference in the episode-of-care costs according to discharge disposition, with discharge to an inpatient rehabilitation facility the most costly and discharge to home the least costly. CONCLUSION: Postdischarge costs represent a sizeable portion of the overall expense in THA, and optimizing patients to allow safe discharge to home may help reduce the cost of THA.


Asunto(s)
Artroplastia de Reemplazo de Cadera/economía , Alta del Paciente/economía , Instituciones de Cuidados Especializados de Enfermería/economía , Adulto , Anciano , Anciano de 80 o más Años , Costos y Análisis de Costo , Bases de Datos Factuales , Episodio de Atención , Honorarios y Precios , Femenino , Gastos en Salud , Humanos , Masculino , Medicare/economía , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos
3.
Surg Technol Int ; 31: 384-388, 2017 Dec 22.
Artículo en Inglés | MEDLINE | ID: mdl-29316600

RESUMEN

INTRODUCTION: This study evaluated differences in: 1) total episode payments, 2) probability of hospital readmission, 3) probability of inpatient rehab facility (IRF) and utilization, and 4) probability of skilled nursing care facility (SNF) utilization in patients who had disuse atrophy and underwent a total knee arthroplasty (TKA) and either did, or did not, receive preoperative home-based neuromuscular electrical stimulation (NMES) therapy. MATERIALS AND METHODS: We used the Medicare limited dataset for a 5% sample of beneficiaries from 2014 and 2015 to construct episodes-of-care for TKA (DRG-470) patients with disuse atrophy who underwent a TKA during the 30 days prior to hospital admission and 90 days post-discharge. Patients were stratified into those who either did or did not receive pre- and postoperative NMES therapy. An ordinary least square (OLS) model was used to estimate the impact of NMES on total episode. Linear probability models were used to estimate the impact of NMES on SNF or IRF utilization and readmission. RESULTS: A $3,274 reduction in episode payments for patients who used preoperative NMES versus those who did not (p<0.001) was demonstrated. The probability of readmission was 12.7% lower for those who used preoperative NMES therapy versus those who did not (p=0.609). The probability of utilizing IRF and SNF was 56.7% (p=0.061) and 46.4% (p=<0.001) lower for those who used pre- and postoperative NMES versus those who did not, respectively. CONCLUSION: Significant reduction in total episode payments and SNF utilization for TKA patients with disuse atrophy who had NMES therapy was demonstrated.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/economía , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Terapia por Estimulación Eléctrica/estadística & datos numéricos , Trastornos Musculares Atróficos , Anciano , Femenino , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Medicare , Trastornos Musculares Atróficos/epidemiología , Trastornos Musculares Atróficos/terapia , Readmisión del Paciente/economía , Readmisión del Paciente/estadística & datos numéricos , Cuidados Posoperatorios/economía , Cuidados Posoperatorios/estadística & datos numéricos , Cuidados Preoperatorios/economía , Cuidados Preoperatorios/estadística & datos numéricos , Estudios Retrospectivos , Instituciones de Cuidados Especializados de Enfermería/economía , Instituciones de Cuidados Especializados de Enfermería/estadística & datos numéricos , Estados Unidos/epidemiología
4.
J Am Geriatr Soc ; 63(11): 2308-16, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26503137

RESUMEN

OBJECTIVES: To determine the cost-effectiveness of two nutrition interventions on food, beverage, and supplement intake and body weight. DESIGN: Randomized, controlled trial. SETTING: Five skilled nursing home facilities. PARTICIPANTS: Long-stay residents with orders for nutrition supplementation (N = 154). INTERVENTION: Participants were randomized into a usual care control group, an oral liquid nutrition supplement (ONS) intervention group, or a snack intervention group. Research staff provided ONS, according to orders or a variety of snack foods and beverages twice per day between meals, 5 days per week for 24 weeks and assistance to promote consumption. MEASUREMENTS: Research staff independently weighed residents at baseline and monthly during the 24-week intervention. Resident food, beverage and supplement intake and the amount of staff time spent providing assistance were assessed for 2 days at baseline and 2 days per month during the intervention using standardized observation and weighed intake procedures. RESULTS: The ONS intervention group took in an average of 265 calories more per day and the snack intervention group an average of 303 calories more per day than the control group. Staff time required to provide each intervention averaged 11 and 14 minutes per person per offer for ONS and snacks, respectively, and 3 minutes for usual care. Both interventions were cost-effective in increasing caloric intake, but neither intervention had a significant effect on body weight, despite positive trends. CONCLUSION: Oral liquid nutrition supplements and snack offers were efficacious in promoting caloric intake when coupled with assistance to promote consumption and a variety of options, but neither intervention resulted in significant weight gain.


Asunto(s)
Cuidados a Largo Plazo/economía , Terapia Nutricional/economía , Anciano de 80 o más Años , Estatura , Análisis Costo-Beneficio , Ingestión de Alimentos , Ingestión de Energía , Femenino , Humanos , Masculino , Terapia Nutricional/métodos , Apoyo Nutricional , Instituciones de Cuidados Especializados de Enfermería/economía , Aumento de Peso
5.
Spec Care Dentist ; 30(3): 95-8, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20500703

RESUMEN

The University of the Pacific, Arthur A. Dugoni School of Dentistry in San Francisco established a comprehensive dental care program at Laguna Honda Hospital, a public, skilled nursing facility. The program had three goals: (1) to provide dental students and residents an opportunity to provide oral health care for adults who were frail and medically compromised who could not come into the clinics, (2) to increase students' access to patients who needed removable prosthodontics, and (3) to fulfill Pacific's commitment to public service. Laguna Honda and Pacific pooled their resources to bring comprehensive dental care to patients who were not able to access the dental school clinics. The long-term goals are to restore and maintain the oral health of those who reside in the facility, and to educate future dentists to provide oral health care for similar populations.


Asunto(s)
Enfermedad Crónica , Relaciones Comunidad-Institución , Atención Odontológica Integral , Hospitales Públicos , Área sin Atención Médica , Facultades de Odontología , Instituciones de Cuidados Especializados de Enfermería , Adulto , Anciano , Anciano de 80 o más Años , Atención Odontológica Integral/economía , Atención Odontológica Integral/organización & administración , Costos y Análisis de Costo , Atención a la Salud/economía , Atención a la Salud/organización & administración , Educación en Odontología , Femenino , Apoyo Financiero , Odontología General/educación , Recursos en Salud , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Hospitales Públicos/economía , Hospitales Públicos/organización & administración , Humanos , Internado y Residencia , Masculino , Persona de Mediana Edad , Objetivos Organizacionales , Grupo de Atención al Paciente , Prostodoncia/educación , San Francisco , Facultades de Odontología/economía , Facultades de Odontología/organización & administración , Instituciones de Cuidados Especializados de Enfermería/economía , Instituciones de Cuidados Especializados de Enfermería/organización & administración , Cirugía Bucal/educación
6.
Health Care Manage Rev ; 31(1): 73-7, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-16493275

RESUMEN

The current health policy of the Finnish government with regard to the production of health services strongly emphasizes productivity and efficiency. On the other hand, the staff generally demand better staffing for nursing facility care. This study incorporates the Resource Utilization Groups (RUG-III) in the calculation of the staffing levels and cost-efficiency and explores the association between cost-efficiency and staff levels in nursing facility care in Finland. The results indicate an improvement potential in case-mix-based staffing. Existing labor resources can be used more fairly and effectively while cost-efficiency differences can be diminished by applying the RUG-III for the allocation of the staff.


Asunto(s)
Hogares para Ancianos/economía , Casas de Salud/economía , Admisión y Programación de Personal/organización & administración , Instituciones de Cuidados Especializados de Enfermería/economía , Benchmarking , Análisis Costo-Beneficio , Grupos Diagnósticos Relacionados , Finlandia , Programas Nacionales de Salud , Admisión y Programación de Personal/economía
7.
Healthc Financ Manage ; 53(8): 31-4, 1999 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-10557797

RESUMEN

Provisions of the Balanced Budget Act of 1997 that focus on postacute services have important ramifications for integrated delivery systems (IDSs) because changes in payment rates for such services create financial incentives to alter patient-flow patterns among acute and postacute care services. In particular, IDSs should understand the provisions of the act that deal with a prospective payment system for skilled nursing services, the definition of a transfer from an acute care hospital, interim and prospective payment systems for home health care, limits imposed by the 1982 Tax Equity and Fiscal Responsibility Act for acute rehabilitation providers, a PPS for acute rehabilitation providers, TEFRA limits for long-term acute care, and limits on outpatient therapy services.


Asunto(s)
Continuidad de la Atención al Paciente/economía , Prestación Integrada de Atención de Salud/economía , Medicare/legislación & jurisprudencia , Sistema de Pago Prospectivo/legislación & jurisprudencia , Atención Subaguda/economía , Atención Ambulatoria/economía , Presupuestos/legislación & jurisprudencia , Servicios de Atención de Salud a Domicilio/economía , Transferencia de Pacientes , Centros de Rehabilitación/economía , Instituciones de Cuidados Especializados de Enfermería/economía , Atención Subaguda/clasificación , Tax Equity and Fiscal Responsibility Act , Estados Unidos
8.
Ann Intern Med ; 108(2): 279-88, 1988 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-3124682

RESUMEN

The availability and delivery of long-term care services in the United States have been hindered by major organizational and financial problems. The American College of Physicians has previously identified and addressed some of the organizational problems that impede access to long-term care. In this issues paper, we provide background information on and analysis of the costs and the methods currently used to finance such care in the United States. The Canadian National Health Care System is also described for comparison. We then analyze such alternative financing mechanisms as private individual insurance (beyond Medigap), employment-based long-term care insurance, self-insurance, vouchers, financing through Medicare, home equity conversions, and prepaid capitated case management plans. The advantages and disadvantages of each of these methods are presented.


Asunto(s)
Financiación Personal/métodos , Servicios de Salud para Ancianos/economía , Seguro de Cuidados a Largo Plazo , Cuidados a Largo Plazo/economía , Anciano , Anciano de 80 o más Años , Canadá , Planes de Asistencia Médica para Empleados , Servicios de Atención de Salud a Domicilio/economía , Humanos , Medicaid , Medicare , Programas Nacionales de Salud , Instituciones de Cuidados Especializados de Enfermería/economía , Estados Unidos
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