Alternative payment models have been touted as a solution to reducing U.S. health care costs.In fact, some people claimed The Affordable Care Act’s focus on alternative payment strategies that shift the burden of health care costs onto health care providers is helping to flatten America’s notoriously steep health care spending curve. That’s what it means.
This is the first study to quantify the impact of a benefit reform on caregivers, showing that some of the cost savings are achieved by shifting costs from Medicare to caregivers, who are typically unpaid family members. It has been found. The finding that savings from these alternative payment models are built in part “on family caregiver support” continues to assess the true economic costs of alternative payment models and supports caregivers. This highlights the growing need for health policy to adopt supportive policy approaches. .
of studyby LDI Executive Director Rachel M. Warner, LDI Research Director Norma B. Ko, Seiyoung Kim, and R. Tamara Konetzka. American Journal of Health Economicsexamined data on more than 2 million Medicare beneficiaries who underwent knee or hip replacements, among the most common surgeries. They found that due to the switch to bundled payments, the need for additional assistance with daily tasks increased by 9% to 15% after paid home health services ended.
Save lump-sum payment for surgery by replacing home care with nursing home care
Bundled payments for common surgeries such as joint replacements were some of the first alternative payment models tested in the Medicare program. Medicare randomly selected 75 metropolitan areas to test these payment models, allowing researchers to leverage a natural randomized experiment to understand the impact of payment policy changes.
The Comprehensive Care (CJR) model for joint replacement is Shown to be successful in reducing Medicare spending Avoid the high medical costs in nursing homes that often occur after joint replacement surgery. Werner et al.’s new study confirms previous findings that in areas where bundled payments were implemented, nursing home care decreased and home health care use increased. They found that the proportion of patients discharged to nursing homes decreased by 2 percentage points, and the proportion of patients discharged to home health services increased by 3 percentage points. We also found that the number of home visits decreased significantly after implementing the payment changes. At the end of the home care episode, patients needed more support from their caregivers than before bundled payments were used. Although the transition to home care is often consistent with the patient’s wishes, there are hidden costs for the family.
Introduction of bundled payments means more patients can receive support from carers after being discharged from home health care
Decrease in paid care means an increase in unpaid care
Werner et al.’s study showed that although paid care (i.e., homestays and home health visits) has decreased, patients’ need for assistance with activities of daily living has not disappeared, and care providers are now providing care instead. By quantifying it, we broke new ground. .Across the United States, more than 38 million US adults Provide unpaid care to family members.
Increasing caregiving burdens raise concerns about the impact on caregivers’ financial, physical, and mental health. for example, the study We know that family caregivers are more likely to take time off from work, take out loans or mortgages, deplete their savings, work multiple jobs, or retire early. Women are more often affected than men. “Based on known caregiver demographics,” the authors write, “unpaid care costs are likely to be borne disproportionately by women of color.”
Preliminary evaluation of CJR model You’ll save an estimated $500 to $800 per surgery. The researchers noted that while the total dollar value of unpaid wages alone for family caregivers may be less than Medicare savings, a complete accounting would require assessing the broader economic and health impacts on caregivers. points out that it is necessary.
Ripple effects need to be considered to understand the true cost of payment reform
Alternative payment models have the potential to reduce health care costs and improve quality of care and health equity, but payment changes must be made to ensure that policy changes do not have unintended consequences. It is essential that you understand all the implications. Werner et al.’s quantification of the extent to which system savings translate into costs borne by family caregivers provides a blueprint for evaluating current models and designing the next generation of payment policies.
the study, “Impact of post-acute care benefit reform on nursing care needs and acceptance of nursing care” will be published. American Journal of Health Economics (Coming soon). Authors include Rachel M. Warner, Norma B. Ko, Seiyoung Kim, and R. Tamara Konetzka.
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