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
Rivera-Hernandez, Maricruz; Leyva, Bryan; Keohane, Laura M et al. (2016) Quality of Care for White and Hispanic Medicare Advantage Enrollees in the United States and Puerto Rico. JAMA Intern Med 176:787-94
Berridge, Clara; Tyler, Denise A; Miller, Susan C (2016) Staff Empowerment Practices and CNA Retention: Findings From a Nationally Representative Nursing Home Culture Change Survey. J Appl Gerontol :
Mor, Vincent; Rahman, Momotazur; McHugh, John (2016) Accountability of Hospitals for Medicare Beneficiaries' Postacute Care Discharge Disposition. JAMA Intern Med 176:119-21
Rahman, Momotazur; Grabowski, David C; Mor, Vincent et al. (2016) Is a Skilled Nursing Facility's Rehospitalization Rate a Valid Quality Measure? Health Serv Res 51:2158-2175
Schoenfeld, Andrew J; Zhang, Xuan; Grabowski, David C et al. (2016) Hospital-skilled nursing facility referral linkage reduces readmission rates among Medicare patients receiving major surgery. Surgery 159:1461-8
Teno, Joan M; Gozalo, Pedro; Khandelwal, Nita et al. (2016) Association of Increasing Use of Mechanical Ventilation Among Nursing Home Residents With Advanced Dementia and Intensive Care Unit Beds. JAMA Intern Med 176:1809-1816
Rahman, Momotazur; Norton, Edward C; Grabowski, David C (2016) Do hospital-owned skilled nursing facilities provide better post-acute care quality? J Health Econ 50:36-46
Baier, Rosa R; Trivedi, Amal N (2016) For Hospital Readmissions, Hindsight is Not 20/20. J Gen Intern Med 31:1270-1271
Rahman, Momotazur; McHugh, John; Gozalo, Pedro L et al. (2016) The Contribution of Skilled Nursing Facilities to Hospitals' Readmission Rate. Health Serv Res :
Jung, Hye-Young; Trivedi, Amal N; Grabowski, David C et al. (2016) Does More Therapy in Skilled Nursing Facilities Lead to Better Outcomes in Patients With Hip Fracture? Phys Ther 96:81-9

Showing the most recent 10 out of 118 publications