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1.
J Health Econ ; 61: 244-258, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29428772

RESUMO

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.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Medicare/organização & administração , Cuidados Semi-Intensivos/organização & administração , Idoso , Idoso de 80 Anos ou mais , Prestação Integrada de Cuidados de Saúde/economia , Prestação Integrada de Cuidados de Saúde/métodos , Feminino , Agências de Assistência Domiciliar/economia , Agências de Assistência Domiciliar/organização & administração , Administração Hospitalar/economia , Administração Hospitalar/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Medicare/economia , Medicare/estatística & dados numéricos , Modelos Estatísticos , Readmissão do Paciente/estatística & dados numéricos , Instituições de Cuidados Especializados de Enfermagem/economia , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Cuidados Semi-Intensivos/economia , Resultado do Tratamento , Estados Unidos
2.
J Arthroplasty ; 32(10): 2969-2973, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28601245

RESUMO

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.


Assuntos
Artroplastia de Quadril/economia , Alta do Paciente/economia , Instituições de Cuidados Especializados de Enfermagem/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Custos e Análise de Custo , Bases de Dados Factuais , Cuidado Periódico , Honorários e Preços , Feminino , Gastos em Saúde , Humanos , Masculino , Medicare/economia , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
3.
Surg Technol Int ; 31: 384-388, 2017 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-29316600

RESUMO

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.


Assuntos
Artroplastia do Joelho/economia , Artroplastia do Joelho/estatística & dados numéricos , Terapia por Estimulação Elétrica/estatística & dados numéricos , Transtornos Musculares Atróficos , Idoso , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Medicare , Transtornos Musculares Atróficos/epidemiologia , Transtornos Musculares Atróficos/terapia , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Cuidados Pós-Operatórios/economia , Cuidados Pós-Operatórios/estatística & dados numéricos , Cuidados Pré-Operatórios/economia , Cuidados Pré-Operatórios/estatística & dados numéricos , Estudos Retrospectivos , Instituições de Cuidados Especializados de Enfermagem/economia , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Estados Unidos/epidemiologia
4.
J Am Geriatr Soc ; 63(11): 2308-16, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26503137

RESUMO

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.


Assuntos
Assistência de Longa Duração/economia , Terapia Nutricional/economia , Idoso de 80 Anos ou mais , Estatura , Análise Custo-Benefício , Ingestão de Alimentos , Ingestão de Energia , Feminino , Humanos , Masculino , Terapia Nutricional/métodos , Apoio Nutricional , Instituições de Cuidados Especializados de Enfermagem/economia , Aumento de Peso
5.
Spec Care Dentist ; 30(3): 95-8, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20500703

RESUMO

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.


Assuntos
Doença Crônica , Relações Comunidade-Instituição , Assistência Odontológica Integral , Hospitais Públicos , Área Carente de Assistência Médica , Faculdades de Odontologia , Instituições de Cuidados Especializados de Enfermagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Odontológica Integral/economia , Assistência Odontológica Integral/organização & administração , Custos e Análise de Custo , Atenção à Saúde/economia , Atenção à Saúde/organização & administração , Educação em Odontologia , Feminino , Apoio Financeiro , Odontologia Geral/educação , Recursos em Saúde , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Hospitais Públicos/economia , Hospitais Públicos/organização & administração , Humanos , Internato e Residência , Masculino , Pessoa de Meia-Idade , Objetivos Organizacionais , Equipe de Assistência ao Paciente , Prostodontia/educação , São Francisco , Faculdades de Odontologia/economia , Faculdades de Odontologia/organização & administração , Instituições de Cuidados Especializados de Enfermagem/economia , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Cirurgia Bucal/educação
6.
Health Care Manage Rev ; 31(1): 73-7, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16493275

RESUMO

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.


Assuntos
Instituição de Longa Permanência para Idosos/economia , Casas de Saúde/economia , Admissão e Escalonamento de Pessoal/organização & administração , Instituições de Cuidados Especializados de Enfermagem/economia , Benchmarking , Análise Custo-Benefício , Grupos Diagnósticos Relacionados , Finlândia , Programas Nacionais de Saúde , Admissão e Escalonamento de Pessoal/economia
7.
Healthc Financ Manage ; 53(8): 31-4, 1999 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10557797

RESUMO

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.


Assuntos
Continuidade da Assistência ao Paciente/economia , Prestação Integrada de Cuidados de Saúde/economia , Medicare/legislação & jurisprudência , Sistema de Pagamento Prospectivo/legislação & jurisprudência , Cuidados Semi-Intensivos/economia , Assistência Ambulatorial/economia , Orçamentos/legislação & jurisprudência , Serviços de Assistência Domiciliar/economia , Transferência de Pacientes , Centros de Reabilitação/economia , Instituições de Cuidados Especializados de Enfermagem/economia , Cuidados Semi-Intensivos/classificação , Tax Equity and Fiscal Responsibility Act , Estados Unidos
8.
Ann Intern Med ; 108(2): 279-88, 1988 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-3124682

RESUMO

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.


Assuntos
Financiamento Pessoal/métodos , Serviços de Saúde para Idosos/economia , Seguro de Assistência de Longo Prazo , Assistência de Longa Duração/economia , Idoso , Idoso de 80 Anos ou mais , Canadá , Planos de Assistência de Saúde para Empregados , Serviços de Assistência Domiciliar/economia , Humanos , Medicaid , Medicare , Programas Nacionais de Saúde , Instituições de Cuidados Especializados de Enfermagem/economia , Estados Unidos
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