A key policy question for the coming decade is how best to structure incentives and regulations to insure that frail older hospitalized patients receie cost effective and coordinated care. Both federal and state policy has transformed long-term care with the emergence of post-acute care provided by nursing homes (NH) and other providers. Post-acute care now represents approximately 20% of all Medicare spending. Our first Program Project grant focused on the effect of states' Medicaid policies on the strategic choices that NHs make and how those choices impact patient outcomes. We find that not only do states' policies influence providers' investments which can positively or adversely affect residents' outcome, we've also found that Medicare policies affected Medicaid providers and states' Medicaid policies affected Medicare patients, often in a dysfunctional manner. Indeed, Medicare policy changes directed at acute hospitals trickle down to impact most NHs further highlighting the interconnectedness of long term and post-acute care policy domains. Thus, Medicaid and Medicare policies are intertwined; when Medicare policies change, even if only directed at hospitals, NHs and other PAC providers are affected. Since the Affordable Care Act (ACA) represents the biggest policy change to Medicare and Medicaid in decades, we believe it is imperative to understand its effects on the acute care and post-acute care interface. The three projects and cores we propose all focus on the growing role of post-acute care (PAC); each has historical aims as well as aims that examine the impact of the Affordable Care Act (ACA). Project #1 asks whether hospitals with strong relationships with NH partners have lower re-hospitalization rates. Project #2 examines the impact of hospitals' approaches to staffing the attending physician role on frail, hospitalized NH residents experience. Finally, Project #3 examines, for the first time, the use of PAC by Medicare managed care and how patients respond to changing co-pay structures for PAC.

Public Health Relevance

Over the last 4 decades long term care in America has been transformed and is now increasingly serving as post-acute care for Medicare beneficiaries recovering from illness. Since the Affordable Care Act (ACA) is the biggest Medicare policy change in decades, we seek to study the evolution of post-acute care and its response to the many ACA provisions affecting the scope of hospitals' responsibility post-discharge.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Program Projects (P01)
Project #
5P01AG027296-09
Application #
9232047
Study Section
Special Emphasis Panel (ZAG1-ZIJ-3 (01))
Program Officer
Bhattacharyya, Partha
Project Start
2005-12-01
Project End
2019-01-31
Budget Start
2017-02-01
Budget End
2018-01-31
Support Year
9
Fiscal Year
2017
Total Cost
$1,201,907
Indirect Cost
$430,700
Name
Brown University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
001785542
City
Providence
State
RI
Country
United States
Zip Code
02912
Keohane, Laura M; Trivedi, Amal N; Mor, Vincent (2017) Recent Health Care Use and Medicaid Entry of Medicare Beneficiaries. Gerontologist 57:977-986
Thomas, Kali S; Baier, Rosa; Kosar, Cyrus et al. (2017) Individualized Music Program is Associated with Improved Outcomes for U.S. Nursing Home Residents with Dementia. Am J Geriatr Psychiatry 25:931-938
Keohane, Laura M; Grebla, Regina C; Rahman, Momotazur et al. (2017) First-dollar cost-sharing for skilled nursing facility care in medicare advantage plans. BMC Health Serv Res 17:611
Kosar, Cyrus M; Thomas, Kali S; Inouye, Sharon K et al. (2017) Delirium During Postacute Nursing Home Admission and Risk for Adverse Outcomes. J Am Geriatr Soc 65:1470-1475
Dore, David D; Zullo, Andrew R; Mor, Vincent et al. (2017) Age, Sex, and Dose Effects of Nonbenzodiazepine Hypnotics on Hip Fracture in Nursing Home Residents. J Am Med Dir Assoc :
Li, Qijuan; Keohane, Laura M; Thomas, Kali et al. (2017) Association of Cost Sharing With Use of Home Health Services Among Medicare Advantage Enrollees. JAMA Intern Med 177:1012-1018
Ankuda, Claire K; Mitchell, Susan L; Gozalo, Pedro et al. (2017) Association of Physician Specialty with Hospice Referral for Hospitalized Nursing Home Patients with Advanced Dementia. J Am Geriatr Soc 65:1784-1788
Berry, Sarah D; Zullo, Andrew R; Lee, Yoojin et al. (2017) Fracture Risk Assessment in Long-term Care (FRAiL): Development and Validation of a Prediction Model. J Gerontol A Biol Sci Med Sci :
Teno, Joan M; Gozalo, Pedro L; Trivedi, Amal N et al. (2017) Temporal Trends in the Numbers of Skilled Nursing Facility Specialists From 2007 Through 2014. JAMA Intern Med 177:1376-1378
Winblad, Ulrika; Mor, Vincent; McHugh, John P et al. (2017) ACO-Affiliated Hospitals Reduced Rehospitalizations From Skilled Nursing Facilities Faster Than Other Hospitals. Health Aff (Millwood) 36:67-73

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