Effect of medicare prospective payment system on a home health agency: Changes in patient population and services provided

Easton, Laura Stanton; Cogen, Raymond; Fulcomer, Mark C.

doi:10.1016/s0897-1897(05)80066-7

Cited by 3 publications

(2 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In this study, predictors of nursing problems and use focused on a single visit. Other home health researchers have focused on the total amount of home health services used, factors that affect patients' differential use of home health services, changes in home health service use patterns following an event, and descriptions of patients who use versus those who do not use home health services (Ballard & McNamara, 1983;Easton, Cogen, Fulcomer, 1991;Frederiks et al, 1992;Gornick & Hall, 1988;Kemper, 1992;Kornblatt, Fisher, & MacMillan, 1985;Leonard, Brust, & Sielaff, 1991). Thus, future work should clarify differences in results based on the ways the term "use of home health services" has been conceptualized.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing home care nursing problems and nursing care

Helberg

1993

Research in Nursing & Health

View full text Add to dashboard Cite

This study was conducted to determine the contributions of sociodemographic factors, medical conditions, and nursing dependency to nursing problems identified and nursing care provided to patients during a home care nursing visit. Patient interviews, direct observation of nursing care, record abstraction, and nurses' reports were used to obtain data from 438 patients receiving nursing visits from a certified home health agency. Nursing dependency was the strongest predictor of the nursing problems of and nursing care provided to home care patients. Measures of nursing dependency should be incorporated in models to determine the extent of nursing problems and nursing care provided in the home and in models of home care nursing reimbursement.

show abstract

Section: Discussionmentioning

confidence: 99%

Factors influencing home care nursing problems and nursing care

Helberg

1993

Research in Nursing & Health

View full text Add to dashboard Cite

show abstract

“…In den USA zeigte sich ein rapider Anstieg in den Leistungen von Rehabilitationsund Pflegeeinrichtungen [1]. So stiegen die Kosten für die Rehabilitation in den USA von 1990 bis 1994 jährlich um 19,7 %, die Zahl der Entlassungen aus der Rehabilitation verzeichnete im selben Zeitraum einen jährlichen Zuwachs von 13,8 % und die Zahl der Rehabilitationseinrichtungen stieg von 1990 bis 1996 um 28,9 % [2].…”

Section: Introductionunclassified

Finanzierung der Frührehabilitation

Brach¹,

Piek²,

Stucki³

2002

Phys Rehab Kur Med

View full text Add to dashboard Cite

HinweisIn Abstimmung mit der Deutschen Gesellschaft für Physikalische Medizin und Rehabilitation DGPMR der Bundesarbeitsgemeinschaft der Akutkrankenhäuser mit Abteilungen der fachübergreifenden Frührehabilita-tion e. V. dem Berufsverband der in Rehabilitation, Physikalischer Medizin und Prävention tätigen ¾rzte e. V. ZusammenfassungDeutschland steht nach der Verabschiedung des Fallpauschalengesetzes vor der Einführung des aus Australien übernommenen DRG-Systems. Erfahrungen aus den USA und Australien zeigen eine Vielzahl von Konsequenzen für alle Beteiligten. Unsicherheiten und zusätzlicher Regelungsbedarf bestehen bereits beim Start in das DRG-System, insbesondere an Schnittstellen der betroffenen Akut-zur nachgeordneten Versorgung. Es müssen Vergütungsmodelle für die umfassende indikationsübergreifende Frührehabilitation und die ergänzende Frührehabilitation im Akutkrankenhaus entwickelt werden. Die Abbildung dieser Leistungen ist im DRG-System nicht gewährleistet, da eine ausschlieûliche Orientierung am ICD-10 erfolgt. Die Entwicklung von Finanzierungsmodellen in der Rehabilitation muss sich jedoch an den Krankheitskonsequenzen und am individuellen Rehabilitationsbedarf des Patienten orientieren. Die Erfassung der funktionalen Gesundheit gemäû der ICF (International Classification of Functioning, Disability and Health) bildet hierfür eine geeignete Grundlage. Für die Weiterentwickelung des Finanzierungssystems bestehen nur zwei Alternativen. Erstens, Rehabilitationsleistungen werden in das DRG-System integriert. Zweitens, Rehabilitationsleistungen werden auf einer separaten Finanzierungsbasis vergütet. Hauptziel ist die Etablierung eines guten Prädiktors zur Abschätzung des Rehabilitationsbedarfs, der Rehabilitationsdauer und des voraussichtlichen Ressourcenverbrauchs. Damit wird deutlich, dass rehabilitative Leistungen AbstractAfter passing the bill for a new prospective reimbursement system, Germany is now approaching the introduction of the DRGsystem taken over from Australia. Experiences from the USA and Australia show a lot of consequences for all those involved. There are uncertainties right from the beginning, especially concerning the point where acute care meets subordinate care. Payment systems for comprehensive early rehabilitation in acute care have to be developed. The existing DRG-system does not reflect these rehabilitation services as it is only orientated to ICD-10. The development of funding systems in rehabilitation has to take into account, health consequences and individual rehabilitation needs. The registration of functional health, according to the International Classification of Functioning, Disability and Health seems to be an adequate basis. To proceed the payment system there are only two alternatives. First, rehabilitation services are integrated in the DRG-system. Second, rehabilitation services are paid in a different way. The major issue is establishing a good predictor of length of stay, need for rehabilitation and use of resources. This explains why rehabilitation is less deter...

show abstract

Activity-Based Funding of Hospitals and Its Impact on Mortality, Readmission, Discharge Destination, Severity of Illness, and Volume of Care: A Systematic Review and Meta-Analysis

et al. 2014

View full text Add to dashboard Cite

BackgroundActivity-based funding (ABF) of hospitals is a policy intervention intended to re-shape incentives across health systems through the use of diagnosis-related groups. Many countries are adopting or actively promoting ABF. We assessed the effect of ABF on key measures potentially affecting patients and health care systems: mortality (acute and post-acute care); readmission rates; discharge rate to post-acute care following hospitalization; severity of illness; volume of care.MethodsWe undertook a systematic review and meta-analysis of the worldwide evidence produced since 1980. We included all studies reporting original quantitative data comparing the impact of ABF versus alternative funding systems in acute care settings, regardless of language. We searched 9 electronic databases (OVID MEDLINE, EMBASE, OVID Healthstar, CINAHL, Cochrane CENTRAL, Health Technology Assessment, NHS Economic Evaluation Database, Cochrane Database of Systematic Reviews, and Business Source), hand-searched reference lists, and consulted with experts. Paired reviewers independently screened for eligibility, abstracted data, and assessed study credibility according to a pre-defined scoring system, resolving conflicts by discussion or adjudication.ResultsOf 16,565 unique citations, 50 US studies and 15 studies from 9 other countries proved eligible (i.e. Australia, Austria, England, Germany, Israel, Italy, Scotland, Sweden, Switzerland). We found consistent and robust differences between ABF and no-ABF in discharge to post-acute care, showing a 24% increase with ABF (pooled relative risk = 1.24, 95% CI 1.18–1.31). Results also suggested a possible increase in readmission with ABF, and an apparent increase in severity of illness, perhaps reflecting differences in diagnostic coding. Although we found no consistent, systematic differences in mortality rates and volume of care, results varied widely across studies, some suggesting appreciable benefits from ABF, and others suggesting deleterious consequences.ConclusionsTransitioning to ABF is associated with important policy- and clinically-relevant changes. Evidence suggests substantial increases in admissions to post-acute care following hospitalization, with implications for system capacity and equitable access to care. High variability in results of other outcomes leaves the impact in particular settings uncertain, and may not allow a jurisdiction to predict if ABF would be harmless. Decision-makers considering ABF should plan for likely increases in post-acute care admissions, and be aware of the large uncertainty around impacts on other critical outcomes.

show abstract

Effect of medicare prospective payment system on a home health agency: Changes in patient population and services provided

Cited by 3 publications

References 7 publications

Factors influencing home care nursing problems and nursing care

Factors influencing home care nursing problems and nursing care

Finanzierung der Frührehabilitation

Activity-Based Funding of Hospitals and Its Impact on Mortality, Readmission, Discharge Destination, Severity of Illness, and Volume of Care: A Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About