Updated simulation of a prospective payment system for post-acute care
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Urban Institute research report
- Author(s):
- Wissoker, Douglas A., author Garrett, Bowen, author
- Contributor(s):
- Health Policy Center (Urban Institute), issuing body. Medicare Payment Advisory Commission (U.S.), issuing body.
- Publication:
- Washington, DC : Urban Institute, June 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Health Equity -- economics Health Policy Medicare -- economics Models, Economic Subacute Care -- economics United States
- Genre(s):
- Tables Technical Report
- Abstract:
- This report presents the methods used to develop and assess the potential for fee-for-service Medicare to pay for post-acute care (PAC) using a unified prospective payment system (PPS). Our initial work for the Medicare Payment Advisory Commission (MedPAC) on a unified PAC PPS used data from 2013 to demonstrate the potential to pay for post-acute stays based on administrative data available in all four settings-home health agencies (HHAs), skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and long-term care hospitals (LTCHs). The model in that initial PAC PPS work and its estimated impacts are described in detail in Wissoker and Garrett (2016) and updated in Wissoker and Garrett (2019). In this report, we update to our initial modeling of a PAC PPS and estimate impacts of a PAC PPS on PAC providers and beneficiaries. In keeping with the original design and findings from our earlier work, the PAC PPS design described in this paper would pay by stay. Wissoker and Garrett (2018a, 2019) assessed the feasibility of paying by episode rather than by stay. These studies found that an episode-based system would likely overpay short episodes and underpay long episodes and could have undesirable incentive effects. As a result, we model a stay-based payment system. The PAC PPS design in this report responds to our previous finding that a PAC PPS that sets payments without using patient-level functional status data yields profits that are substantially below average (defined as having a payment-to-cost ratio less than average) for low-functioning patients and substantially above average (defined as having a payment-to-cost ratio greater than average) for high-functioning patients. Garrett, Wissoker, and Skopec (2021) investigated whether proxies for functional status could be used that were not subject to systematic misreporting or gaming and concluded that effective proxies are not available. Therefore, in this work, our model uses function measures as predictors. We also present impacts from a payment model excluding function, allowing a direct comparison of the performance of the two versions of the model in explaining costs per stay.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-DC license. (More information)
- Extent:
- 1 online resource (1 PDF file (iv, 57 pages))
- NLM Unique ID:
- 9918697485906676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918697485906676