Explaining Area Variation in the Use of Medicare Home Health Services

Kenney, Genevieve M.; Dubay, Lisa

doi:10.1097/00005650-199201000-00004

Cited by 65 publications

(62 citation statements)

References 2 publications

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“…Although Medicare PAC eligibility criteria are codified in regulations, as a practical matter PAC providers, physicians, and hospitals discharge planners have discretion in interpreting these guidelines. In fact, researchers examining PAC have observed tremendous variation in utilization rates, geographically and by type of discharging hospital (Benjamin 1986;Neu, Harrison and Heilbrunn 1989;Swan and Benjamin 1990;Kenney and Dubay 1992;Schore 1996;Kane et al 1996;Cohen and Tumlinson 1997;Kane et al 2002;MedPAC 2003).…”

Section: W O R K I N G P a P E Rmentioning

confidence: 99%

“…Previous research has noted the importance of the supply or availability of PAC in an area on rates of use (Swan and Benjamin 1990;Kenney and Dubay 1992;Kane et al 1996;Cohen and Tumlinson 1997;MedPAC 2003). The objectives of this study are to develop more refined methods of measuring PAC availability and to assess the relative impact of clinical versus non-clinical factors, especially availability, in determining where patients go for PAC services.…”

Section: W O R K I N G P a P E Rmentioning

confidence: 99%

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How Much is Post-Acute Care Use Affected by Its Availability?

Buntin

Garten

Paddock

et al. 2004

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Section: W O R K I N G P a P E Rmentioning

confidence: 99%

Section: W O R K I N G P a P E Rmentioning

confidence: 99%

How Much is Post-Acute Care Use Affected by Its Availability?

Buntin

Garten

Paddock

et al. 2004

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“…However, the appropriateness of home care and patients' ability to use it depend on the availability of support in the home. Several studies using data from the late 1980s and early 1990s reported that the settings in question are sometimes interchangeable (Neu, Harrison, and Heilbrunn 1989;Swan and Benjamin 1990;Kenney and Dubay 1992;Kenney 1993;Cohen and Tumlinson 1997;Kramer et al 1997). Neu, Harrison, and Heilbrunn (1989) suggested that SNF and HHA services are substitutable for one another in urban areas.…”

Section: Introductionmentioning

confidence: 99%

Changes in the Use of Postacute Care during the Initial Medicare Payment Reforms

Lin

Kane

Mehr

et al. 2006

Health Services Research

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Objective. To examine changes in postacute care (PAC) use during the initial Medicare payment reforms enacted by the Balanced Budget Act of 1997. Data Sources. We used claims data from the 5 percent Medicare beneficiary sample in 1996, 1998, and 2000. Linked data from the Denominator file, Provider of Service file, and Area Resource File provided additional patient, hospital, and market-area characteristics. Study Design. Six disease groups with high PAC use were selected for analysis. We used multinomial logit regression to examine how PAC use differed by year of service, controlling for patient, hospital, and market-area characteristics. Principal Findings. There were major changes in PAC use, and a portion of services shifted to settings where reimbursement remained cost-based. During the first reform, the home health agency interim payment system, home health use decreased consistently across disease groups. This decrease was accompanied by increased use in skilled nursing facilities (SNFs). Following the implementation of the prospective payment system for SNFs, the use of inpatient rehabilitation facilities increased. Conclusions. The shift in usage among settings occurred in two stages that corresponded to the timing of payment reforms for home health agencies and SNFs. Evidence strongly suggests the substitutability between PAC settings. Financial incentives, in addition to clinical needs and individual preferences, play a major role in PAC use.Key Words. Postacute care, skilled nursing facility, rehabilitation, home health care, Balanced Budget Act Medicare postacute care (PAC) services provide recuperative or rehabilitative services to patients discharged from acute-care hospitals. As hospital length of stays shortened considerably after the hospital prospective payment system implemented in 1983, these services became a critical transition in the continuum of care for elderly patients. These services--mainly skilled nursing In response to such dramatic increases and with widespread administrative and legislative concerns about possible fraud and abuse by providers, both regulators and legislators devoted considerable attention to PAC services in the mid-1990s. Regulators aggressively pursued potential fraud and abuse, particularly in HHAs, whereas Congress mandated payment reforms in the Balanced Budget Act of 1997. These regulatory compliance initiatives and the sequential implementation of payment reforms had the potential to lead to reimbursementdriven substitution between settings without regard to the appropriateness of care. Nevertheless, most studies of PAC payment reforms have focused on each setting in isolation, with little investigation of how they might be used interchangeably. To our knowledge, no analyses have simultaneously considered all three major PAC settings across years and used multivariate methods to control for variables affecting their use. Using such an approach, we examined how usage shifted among PAC settings as payment reforms introduced new financial incentives.

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“…For example, a number of researchers have explored cross-sectional regional variation in the use of various types of post-acute care. Kenney and Dubay (1992) found that MSAs with fewer nursing home beds per enrollee, higher hospital discharge rates, shorter mean LOSs, higher ceilings for HHA payments, and more home health agencies per enrollee used more home health care. They also found that the number of home health visits was higher in areas with more agencies and where more agencies were proprietary.…”

Section: Analytic Issuesmentioning

confidence: 98%

Centers for Medicare and Medicaid Services

2009

Health Care Policy and Politics a to Z

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Explaining Area Variation in the Use of Medicare Home Health Services

Cited by 65 publications

References 2 publications

How Much is Post-Acute Care Use Affected by Its Availability?

How Much is Post-Acute Care Use Affected by Its Availability?

Changes in the Use of Postacute Care during the Initial Medicare Payment Reforms

Centers for Medicare and Medicaid Services

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