Implementation of US Post-Acute Care Payment Reform and COVID-19 Policies: Examining Experiences of Health System Leaders, Staff, Patients, and Family Caregivers—A Protocol

Natalie E. Leland (), Stephanie A. Rouch, Rachel A. Prusynski, Amanda D. Shore, Hannah Kaufman, Lorelei P. Hoover, Tracy M. Mroz, Janet K. Freburger and Debra Saliba
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Natalie E. Leland: Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA
Stephanie A. Rouch: Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA
Rachel A. Prusynski: Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
Amanda D. Shore: Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA
Hannah Kaufman: Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
Lorelei P. Hoover: Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA
Tracy M. Mroz: Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
Janet K. Freburger: Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA
Debra Saliba: Veterans Affairs (VA) Greater Los Angeles Geriatrics Research Education and Clinical Center (GRECC), Los Angeles, CA 90095, USA

IJERPH, 2023, vol. 20, issue 20, 1-16

Abstract: In fiscal year 2020, new national Medicare payment models were implemented in the two most common post-acute care settings (i.e., skilled nursing facilities (SNFs) and home health agencies (HHAs)), which were followed by the emergence of COVID-19. Given concerns about the unintended consequence of these events, this study protocol will examine how organizations responded to these policies and whether there were changes in SNF and HHA access, care delivery, and outcomes from the perspectives of leadership, staff, patients, and families. We will conduct a two-phase multiple case study guided by the Institute of Medicine’s Model of Healthcare Systems. Phase I will include three cases for each setting and a maximum of fifty administrators per case. Phase II will include a subset of Phase I organizations, which are grouped into three setting-specific cases. Each Phase II case will include a maximum of four organizations. Semi-structured interviews will explore the perspectives of frontline staff, patients, and family caregivers (Phase II). Thematic analysis will be used to examine the impact of payment policy and COVID-19 on organizational operations, care delivery, and patient outcomes. The results of this study intend to develop evidence addressing concerns about the unintended consequences of the PAC payment policy during the COVID-19 pandemic.

Keywords: home healthcare; skilled nursing facility; mixed methods; multiple case study; patient-driven payment model; patient-driven groupings model; post-acute care; COVID-19 (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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