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.

Public Health Relevance

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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Program Projects (P01)
Project #
5P01AG027296-09
Application #
9232056
Study Section
Special Emphasis Panel (ZAG1-ZIJ-3)
Project Start
Project End
Budget Start
2017-02-01
Budget End
2018-01-31
Support Year
9
Fiscal Year
2017
Total Cost
$164,340
Indirect Cost
$58,298
Name
Brown University
Department
Type
Domestic Higher Education
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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