A Comparison of Skilled Nursing Facility Rehabilitation Treatment and Outcomes Under Medicare Managed Care and Medicare Fee-for-Service Reimbursement
作者:Joseph J. Angelelli、Kathleen H. Wilber、Robert Myrtle
DOI:10.1093/geront/40.6.646
日期:2000.12.1
Purpose: This article compares the rehabilitation treatment and outcomes of Medicare managed care organization (MCO) and fee-for-service (FFS) patients in skilled nursing facilities (SNFs). Design and Methods: Data on 514 MCO patients and 420 FFS patients treated in four for-profit Southern California-based SNFs between June 1996 and September 1998 were analyzed with bivariate and multivariate regression models. Results: After controlling for time since onset and other sociodemographic and health status characteristics, Medicare MCO patients were found to receive significantly fewer therapy units and have significantly shorter lengths of stay in rehabilitation programs. Implications: The findings may be the result of more global differences in the trajectories of care among MCO and FFS patients treated in SNFs, yet they highlight critical issues related to the spread of Medicare managed care in nursing homes and the dynamic between MCO and FFS reimbursement systems.
目的:本文比较了医疗保险管理式医疗组织(MCO)和按服务收费(FFS)患者在接受专业护理机构(SNFs)治疗时的康复治疗和结果。设计及方法:1996年6月至1998年9月期间,在南加州的四家营利性专业护理机构接受治疗的514名MCO患者和420名FFS患者的数据,通过双变量和多变量回归模型进行了分析。结果:在控制了发病时间以及其他社会人口统计学和健康状况特征后,发现医疗保险MCO患者接受的治疗次数明显较少,在康复项目中的停留时间也明显更短。意义:这些发现可能是由于在专业护理机构接受治疗的MCO和FFS患者之间的护理轨迹存在更多全球差异,但它们强调了与医疗保险管理式医疗在养老院中的普及以及MCO和FFS报销系统之间的动态变化有关的关键问题。