A recent study compared Medicare fee-for-service beneficiaries to Medicare Advantage beneficiaries, both with hip fractures, to determine if payment structured changed the nature, timing, and outcomes of care.
This was a retrospective cohort study to examine differences in health service utilization and outcomes between FFS and MA patients in SNFs following hip fracture hospitalization during the period January 1, 2011, to June 30, 2015, and followed up until December 31, 2015.
The six primary outcomes of interest in this study included two process measures and four patient-centered outcomes. Process measures included length of stay in the SNF and average rehabilitation therapy minutes (physical and occupational therapy) received per day. Patient-centered outcomes included 30-day hospital readmission, changes in functional status as measured by the 28-point late loss MDS-ADL scale, likelihood of becoming a long-term resident, and successful discharge to the community. Successful discharge from a SNF was defined as being discharged to the community within 100 days of SNF admission and remaining alive in the community without being institutionalized in any acute or post-acute setting for at least 30 days.
Researchers analyzed 211,296 FFS and 75,554 MA patients with hip fracture admitted directly to a SNF following an index hospitalization who had not been in a nursing facility or hospital in the preceding year. They found that compared to FFS patients, MA patients had a shorter course of rehabilitation but were more likely to be discharged to the community successfully and were less likely to experience a 30-day hospital readmission. Longer lengths of stay may not translate into better outcomes in the case of hip fracture patients in SNFs
Researchers wrote that these conclusions indicate that:
- The findings of this study suggest that reducing the duration of rehabilitation care in skilled nursing facilities may be achieved without adversely affecting the quality of rehabilitation care or the health outcomes experienced by hip fracture patients.
- These findings cannot necessarily be extrapolated to other conditions requiring extensive rehabilitation, so future research should be undertaken to determine whether these findings can be extended beyond outcomes for hip fracture patients.
- The results of this study could inform the current debate on value-based payment reform in post-acute care settings in the US.