患者驱动的支付模式,熟练护理机构编码强度和医疗保险支出
Fangli Geng1, Xinran Lu1, Elizabeth M White1
1Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island.
JAMA internal medicine
|July 21, 2025
概括
患者驱动支付模式 (PDPM) 增加了熟练护理机构 (SNF) 的编码强度和医疗保险支出. 然而,它并没有显著改变患者再入院或死亡率.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健服务研究 医疗服务研究
- 老年学是一门学科.
背景情况:
- 患者驱动支付模式 (PDPM) 将医疗保险对熟练护理设施 (SNF) 的报销从治疗量转移到患者特征.
- 了解PDPM对编码,支出和结果的影响对于政策评估至关重要.
研究的目的:
- 评估SNF诊断编码强度的变化,医疗保险支出,以及PDPM实施前后的患者结果.
- 评估PDPM和SNF编码强度,医疗保险支出和患者结果之间的关联.
主要方法:
- 使用回归不连续性分析的回顾性队列研究.
- 分析了65岁以上的传统医疗保险受益人,他们被录取到SNF进行后急性护理 (2018年1月至2020年2月).
- 在2019年10月1日PDPM实施之前和之后的结果进行了比较.
主要成果:
- 实施PDPM显著增加了SNF相对编码强度 (0.54分;P<.001).
- 在PDPM之后,SNF事件支出增加了665美元 (P <.001).
- 没有观察到30天再住院或死亡率的显著变化.
结论:
- 实施PDPM导致了SNF的编码强度和医疗保险支出增加,但没有影响患者死亡率或再接收率.
- 作为对PDPM激励措施的回应,SNF似乎调整了编码实践.
- 持续监测至关重要,以确保PDPM的财务激励措施支持准确的编码,公平的报销和优质的护理.
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