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The impact of post acute care payment changes on access and outcomes

Award Number: R01AG065371
ORGANIZATION: NATIONAL INSTITUTE ON AGING
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 01/15/2021
PERIOD OF PERFORMANCE END DATE: 12/31/2025

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The impact of post acute care payment changes on access and outcomes - Project Summary/Abstract Substantial changes in Medicare payment policies are occurring for post-acute care (PAC), which provides a bridge from the hospital to home for individuals who require medical and rehabilitation (i.e., physical, occupational, and speech therapy) services to transition successfully back to the community. Skilled nursing facilities (SNFs) and home health agencies (HHAs) account for almost 80% of PAC spending. Rapid growth in PAC spending has been driven largely by prior payment systems that incentivized therapy services. However, new payment models were implemented in October 2019 for SNFs and January 2020 for HHAs that attempt to address (a) the growth in spending and (b) the potential for misuse of therapy services. These new models remove incentives for therapy but do not include controls for quality (e.g., community discharge, readmissions). In response, PAC stakeholders have raised concerns that payment reform may differentially impact access to and quality of care for vulnerable populations (e.g., racial and ethnic minorities, dually-eligible, rural-residing) and diagnostic subgroups (e.g., dementia/Alzheimer’s, hip fracture) due to changing reimbursements. While the new models are intended to promote appropriate and efficient care, the actual impact of payment reform is unknown. We hypothesize that SNFs and HHAs will not respond uniformly to changing reimbursements and that the new payment models will adversely impact quality of care for some, but not all, patient populations. Therefore, our overarching goal is to evaluate the impact of payment reform overall and among vulnerable populations and diagnostic subgroups. Using a natural experiment design that capitalizes on the timing of payment reform and a mixed methods approach that uses rich qualitative data collected from SNF and HHA staff and patients, as well as extensive patient-level Medicare claims and assessment data, we will: Aim 1: Identify SNF and HHA organizational responses to payment reform by quantifying changes in therapy staffing and payer mix pre-post payment reform and qualitatively exploring stakeholder perspectives on organizational processes, barriers, and facilitators to providing high-quality care under the new models. Aim 2: Characterize access to SNF and HHA after hospital discharge and utilization of therapy within SNF/HHA pre-post-payment reform overall and for vulnerable populations and diagnostic subgroups. Aim 3: Quantify the association between therapy utilization and quality outcomes (e.g., functional change) pre-post payment reform overall and for vulnerable populations and diagnostic subgroups. Rigorous qualitative and quantitative methodologies will allow us to (a) evaluate whether payment reform has the intended result of incentivizing efficient care and (b) identify any unintended consequences related to disparities in access to care and compromised quality. Findings will address stakeholders’ concerns and provide critical information to policymakers, providers, system leaders, and payers on the impact of payment reform on patient access and quality across patient populations, including the most vulnerable.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = -$5,806 )
2026	2024	UNIVERSITY OF PITTSBURGH - OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION	4200 FIFTH AVENUE	PITTSBURGH	PA	15260	ALLEGHENY	USA	Aging Research	000	4	5/18/2026	NON-COMPETING CONTINUATION	-$5,806
														Subtotal = -$5,806

Issue Date FY: 2024 ( Subtotal = $547,289 )
2024	2024	UNIVERSITY OF PITTSBURGH - OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION	4200 FIFTH AVENUE	PITTSBURGH	PA	15260	ALLEGHENY	USA	Aging Research	003	4	6/4/2024	NON-COMPETING CONTINUATION	$67,773
2024	2024	UNIVERSITY OF PITTSBURGH - OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION	4200 FIFTH AVENUE	PITTSBURGH	PA	15260	ALLEGHENY	USA	Aging Research	002	4	1/5/2024	NON-COMPETING CONTINUATION	$609,955
2024	2023	UNIVERSITY OF PITTSBURGH - OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION	4200 FIFTH AVENUE	PITTSBURGH	PA	15260	ALLEGHENY	USA	Aging Research	001	3	11/2/2023	NON-COMPETING CONTINUATION	-$39,750
2024	2022	UNIVERSITY OF PITTSBURGH - OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION	4200 FIFTH AVENUE	PITTSBURGH	PA	15260	ALLEGHENY	USA	Aging Research	000	2	11/2/2023	NON-COMPETING CONTINUATION	-$90,689
														Subtotal = $547,289

Issue Date FY: 2023 ( Subtotal = $699,463 )
2023	2023	UNIVERSITY OF PITTSBURGH - OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION	4200 FIFTH AVENUE	PITTSBURGH	PA	15260	ALLEGHENY	USA	Aging Research	000	3	1/17/2023	NON-COMPETING CONTINUATION	$699,463
														Subtotal = $699,463

Issue Date FY: 2022 ( Subtotal = $718,685 )
2022	2022	UNIVERSITY OF PITTSBURGH, THE	4200 5TH AVE	PITTSBURGH	PA	15260	ALLEGHENY	USA	Aging Research	001	2	4/26/2022	NON-COMPETING CONTINUATION	$71,870
2022	2022	UNIVERSITY OF PITTSBURGH, THE	4200 5TH AVE	PITTSBURGH	PA	15260	ALLEGHENY	USA	Aging Research	000	2	1/19/2022	NON-COMPETING CONTINUATION	$646,815
														Subtotal = $718,685

Issue Date FY: 2021 ( Subtotal = $770,738 )
2021	2021	UNIVERSITY OF PITTSBURGH THE	3520 FIFTH AVE	PITTSBURGH	PA	15213	ALLEGHENY	USA	Aging Research	001	1	2/4/2021	NEW	$0
2021	2021	UNIVERSITY OF PITTSBURGH THE	3520 FIFTH AVE	PITTSBURGH	PA	15213	ALLEGHENY	USA	Aging Research	000	1	1/14/2021	NEW	$770,738
														Subtotal = $770,738

Grand Total All Awards = $2,730,369

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The impact of post acute care payment changes on access and outcomes

Award Number: R01AG065371

ORGANIZATION: NATIONAL INSTITUTE ON AGING

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 01/15/2021

PERIOD OF PERFORMANCE END DATE: 12/31/2025

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