Initial Home Health Outcomes under Prospective Payment

Autor: Robert E. Schlenker, Martha C. Powell, Glenn K. Goodrich
Rok vydání: 2005
Předmět:
Zdroj: Health Services Research. 40:177-193
ISSN: 1475-6773
0017-9124
Popis: The Prospective Payment System (PPS) for Medicare home health services was implemented in October 2000. The PPS replaced the Interim Payment System (IPS), which was implemented in 1997 as part of the Balanced Budget Act of 1997 (BBA). The IPS placed stringent limits on the Medicare cost-based reimbursement system then in effect. Both IPS and PPS were intended to constrain Medicare home health expenditures, which had increased rapidly in the preceding decade (from $2 billion to over $17 billion between 1988 and 1997 [MedPAC 1998]). IPS was associated with dramatic expenditure and visit reductions between 1997 and 1999. Medicare expenditures declined 53 percent to $7.9 billion (CMS 2003), still comprising about 5 percent of total Medicare expenditures. Two recent articles estimate that home health visits per user declined by about 40 percent (Komisar 2002; McCall et al. 2003). Whether the reduction in visits per user under IPS affected patient outcomes is uncertain. McCall et al. (2002) found mixed results based on selected utilization measures derived from Medicare claims data as proxy outcome indicators. Based on multivariate analyses for fiscal years 1997 and 1999, in the 120 day period after home health admission, hospital admissions decreased while skilled nursing facility admissions, emergency room use, and mortality increased. Although the study authors urge caution in attributing the changes to IPS, it is possible that the stringency of IPS resulted in a decline in patient outcomes. The PPS encouraged further visit reductions. Under PPS, a prospectively determined per-episode payment rate is case-mix adjusted using 80 mutually exclusive Home Health Resource Groups (HHRGs). Each Medicare episode is classified into an HHRG using a subset of items from the Outcome and Assessment Information Set (OASIS), which has been collected by all Medicare-certified home health agencies since mid-1999 (HCFA 1999a). The PPS creates strong financial incentives to minimize service provision because per-episode payments do not vary according to the quantity or mix of services provided. A study by the U.S. General Accounting Office (USGAO 2002) found that average visits per episode declined by 24 percent (29–22 visits) from just prior to PPS to the first half of 2001. The reduction in visits per episode under PPS compounded the already substantial decline under IPS and raises the possibility of poorer outcomes under PPS. Alternatively, if PPS outcome changes are minimal, then the visit reductions may represent a gain in the overall efficiency and cost-effectiveness of home health care. The OASIS data provide uniform, standardized outcome measures to test these possibilities. (The late-IPS period must be used as the baseline, since national OASIS data were not collected earlier.)
Databáze: OpenAIRE
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