Incentives for Access: Changes in Admissions and Care Delivery for Metastatic Cancer Patients in Medicare Skilled Nursing Facilities, After the Patient-Driven Payment Model.

IF 2 3区医学 Q2 GERONTOLOGY

Journal of Applied Gerontology Pub Date : 2026-10-14 DOI:10.1177/07334648261494384

Harsha Amaravadi, Rachel A Prusynski, Paul Fishman, Amanda I Phipps, Natalie E Leland, Tracy M Mroz

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引用次数: 0

Abstract

BackgroundCancer patients experience suboptimal care in skilled nursing facilities (SNFs). Medicare's Patient-Driven Payment Model (PDPM) incentivized SNFs to admit complex patients, potentially promoting admissions without appropriate changes in care delivery.ObjectiveTo evaluate changes in SNF admissions, rehabilitation therapy volume, and chemotherapy/radiation around admission or discharge, following PDPM and COVID-19.MethodsAdjusted interrupted time series examining 1,125,782 hospital stays from metastatic cancer patients, using 100% Traditional Medicare claims (2018-2021).ResultsPDPM was associated with increased SNF admissions (0.47 pp/month; 95% CI: [0.17, 0.76]) and an immediate reduction in therapy volume (-24.95 minutes per day, 95% CI: [-26.40, -23.48]). Chemotherapy use remained low, but increased by 21% at PDPM implementation, without subsequent slope change (RR: 1.21; 95% CI: [1.01, 1.46]); radiation was unchanged. COVID-19 reversed admission gains. SNF admissions for metastatic cancer patients increased without sustained changes in cancer-relevant care delivery, warranting investigation of health outcomes and outcome-driven policy.

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来源期刊

Journal of Applied Gerontology GERONTOLOGY-

CiteScore

5.10

自引率

13.30%

发文量

202

期刊介绍： The Journal of Applied Gerontology (JAG) is the official journal of the Southern Gerontological Society. It features articles that focus on research applications intended to improve the quality of life of older persons or to enhance our understanding of age-related issues that will eventually lead to such outcomes. We construe application broadly and encourage contributions across a range of applications toward those foci, including interventions, methodology, policy, and theory. Manuscripts from all disciplines represented in gerontology are welcome. Because the circulation and intended audience of JAG is global, contributions from international authors are encouraged.