Medicare spending on post-acute care has exploded in the past decade, catalyzing intense policy interest in strategies to reduce post-acute expenditures without harming health or increasing the offsetting costs of other health services. Under the traditional Medicare benefit design, the first 20 days of skilled nursing facility care and all episodes of home care are provided free (i.e. without a copayment), raising concerns about patients'incentives to overuse these services, even when they are of little or no value. To address this concern President Obama, the Medicare Payment Advisory Commission, and the Simpson-Bowles deficit reduction committee have all expressed support for the imposition of a copayment for the use of post-acute care. Yet, there is no empirical evidence base to predict, the impact of such policies. The objective of this proposal is to evaluate the impact of changes in cost-sharing on the use and outcomes of post-acute care using a quasi-experimental research design and a national sample of Medicare enrollees in managed care plans. The central hypotheses of the proposed research, which is based on the results of an extensive series of preliminary studies, are that copayments will sharply reduce the use of post-acute care, induce shifts to other post-acute services with lower out-of-pocket costs, drive hospitalized beneficiaries out of managed care plans into the fee-for-service system, and increase hospital length of stay and the probability of readmission. Our expectations are that this project will provide rigorous estimates of the response of Medicare beneficiaries to post-acute copayments and contribute significantly to our understanding of the effect of cost-sharing among the elderly, who were excluded from the landmark RAND Health Insurance Experiment conducted in the 1970's: Finally, this research can inform optimal Medicare benefit policies that promote better health outcomes and the appropriate use of post-acute services while minimizing negative unintended consequences for frail elderly and the Medicare program budget.
Policymakers are considering imposing copayments for Medicare beneficiaries to use skilled nursing facilities and home health care, but there is no evidence about the impact of requiring out-of-pocket payments for such services. The objective of this project is to examine the effect of changes in copayments for post-acute care among elderly enrollees in Medicare managed care plans.
|Rahman, Momotazur; Foster, Andrew D (2015) Racial segregation and quality of care disparity in US nursing homes. J Health Econ 39:16-Jan|
|Rahman, Momotazur; Tyler, Denise; Thomas, Kali S et al. (2015) Higher Medicare SNF care utilization by dual-eligible beneficiaries: can Medicaid long-term care policies be the answer? Health Serv Res 50:161-79|
|Teno, Joan; Meltzer, David O; Mitchell, Susan L et al. (2014) Type of attending physician influenced feeding tube insertions for hospitalized elderly people with severe dementia. Health Aff (Millwood) 33:675-82|
|Clark, Melissa A; Roman, Anthony; Rogers, Michelle L et al. (2014) Surveying multiple health professional team members within institutional settings: an example from the nursing home industry. Eval Health Prof 37:287-313|
|Miller, Susan C; Lepore, Michael; Lima, Julie C et al. (2014) Does the introduction of nursing home culture change practices improve quality? J Am Geriatr Soc 62:1675-82|
|Rahman, Momotazur; Grabowski, David C; Gozalo, Pedro L et al. (2014) Are dual eligibles admitted to poorer quality skilled nursing facilities? Health Serv Res 49:798-817|
|Thomas, Kali S; Wysocki, Andrea; Intrator, Orna et al. (2014) Finding Gertrude: The resident's voice in Minimum Data Set 3.0. J Am Med Dir Assoc 15:802-6|
|Schneider, Julie M; McMahon, Catherine M; Gopinath, Bamini et al. (2014) Dual sensory impairment and hearing aid use among clients attending low-vision services in Australia: the vision-hearing project. J Aging Health 26:231-49|
|Thomas, Kali S (2014) The relationship between older Americans act in-home services and low-care residents in nursing homes. J Aging Health 26:250-60|
|Fulton, Ana Tuya; Gozalo, Pedro; Mitchell, Susan L et al. (2014) Intensive care utilization among nursing home residents with advanced cognitive and severe functional impairment. J Palliat Med 17:313-7|
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