Medicare Prospective Payment and Posthospital Transfers to Subacute Care

Morrisey, Michael A.; Sloan, Frank A.; Valvona, Joseph

doi:10.1097/00005650-198807000-00004

Cited by 57 publications

(51 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Numerous studies that have explored the impact of Medicare's introduction of prospective payment based on diagnosis-related groups in acute care hospitals in 1983. [24][25][26][27][28][29][30][31][32] These studies indicate that prospective payment reduced hospital costs by reducing the average LOS. [24][25][26]29,30 A large study 27,33 of Medicare beneficiaries (n=16,758) in which half were hospitalized prior to prospective payment and half after found that the overall quality of care, measured by comparing the care received to particular standards (ie, not by measures of outcome) and the process of care improved following the introduction of prospective payment.…”

Section: Discussionmentioning

confidence: 81%

“…26 Changes in the utilization of service beyond acute care hospitals also occurred, as the percentage of people who transferred to subacute facilities such as SNFs, intermediate care facilities, and home health agencies increased. 24,32 A particular strength of this study is that it captured the actual changes in specific rehabilitation services (PT, OT), rather then inferring that the changes in therapy service provision paralleled overall changes occurring in specific sectors. In the case of home health agencies in particular, the large reductions in spending seen in some studies might have obscured the fact that the provision of specific PT and OT services actually increased.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Did the 1997 Balanced Budget Act Reduce Use of Physical and Occupational Therapy Services?

Latham

Jette

Ngo

et al. 2008

Archives of Physical Medicine and Rehabilitation

View full text Add to dashboard Cite

Objective-To investigate whether use of physical therapy (PT) and occupational therapy (OT) services decreased after the passage of the 1997 Balanced Budget Act (BBA). Design-Data from the nationally representative Medicare Current Beneficiary Survey (MCBS)were merged with Medicare claims data. We conducted cross-sectional analyses of data from 1995 (n=7978), 1999 (n=7863), and 2001 (n=7973). All analyses used MCBS sampling weights to provide estimates that can be generalized to the Medicare population with 5 common conditions. Settings-Skilled nursing facilities (SNFs), home health agencies, inpatient rehabilitation facilities (IRFs), and outpatient rehabilitation settings.Participants-Medicare beneficiaries who participated in the MCBS survey in each of the study years and had 1 or more of the following conditions: acute stroke, acute myocardial infarction, chronic obstructive pulmonary disease, arthritis or degenerative joint disease, or mobility problems. Interventions-Not applicable.Main Outcome Measures-Percentage of persons meeting our inclusion criteria who received PT or OT in each setting, and total units of PT and OT received in each setting.Results-Multivariable logistic regression revealed no statistically significantly differences in the proportion of people who met our inclusion criteria who used PT or OT from home health agencies across the 3 time points. For SNFs, an increase in the odds of receiving PT was statistically significant from 1995 to 1999 (odds ratio [OR] Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. This article uses a nationally representative database to analyze the use of 2 PAC servicesphysical (PT) and occupational therapy (OT)-by Medicare beneficiaries with five common diagnoses across various settings of care before and after the 1997 BBA. Looking simultaneously at service use across different rehabilitation settings is important because changes in 1 sector could alter care patterns in another setting. Additionally, exploring changes in service use is complicated by differing timeframes for implementing BBAmandated prospective payment across PAC settings (fig 1). For instance, the BBA created an interim payment system for home health agencies, which was phased in over 12 months beginning October 1, 1997, and controlled both average spending per visit and per Medicare beneficiary; full home health agency prospective payment was implemented in October 2000. A prospective payment system (PPS) was implemented for SNFs in July 1998, and in January 2002 for IRFs. For outpatient therapy, the BBA imposed 2 annual $1500 caps-one for PT...

show abstract

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Did the 1997 Balanced Budget Act Reduce Use of Physical and Occupational Therapy Services?

Latham

Jette

Ngo

et al. 2008

Archives of Physical Medicine and Rehabilitation

View full text Add to dashboard Cite

show abstract

“…This increase was independent of all other factors. One of the factors responsible for this may be the incentive to reduce the amount of time spent in acute care hospitals since the implementation of the Prospective Payment System [19][20][21][22]. This system gives hospitals a financial incentive to care for patients in the least costly manner possible, accounting for efforts to reduce time spent in acute care hospitals.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Discharge to a Skilled Nursing Facility following Hip Fracture Surgery in New York State

et al. 2004

View full text Add to dashboard Cite

Background: Hip fracture is always a very traumatic event, especially for an older person. Often, it is followed by a marked decrease in the level of functioning a patient is able to achieve after recovery. It is even more debilitating when a previously independent person must be discharged to an institution. Objective: This study examined factors and trends associated with discharge to a skilled nursing facility following hip fracture surgery. Methods: Data were analyzed for 89,723 hip fracture patients admitted in New York State from 1986 to 1996. Factors examined included age, gender, race, type of fracture, surgical technique, comorbidities, length of hospitalization and year of admission. Results: Thirty-five percent (32,130) of the patients were discharged to skilled nursing facilities. They tended to be 85+ years old, female, white, have 3+ comorbidities, a history of dementia, have sustained an intertrochanteric fracture, and have been admitted after 1990. In addition, there was a gradual increase in institutionalizations after 1990. Conclusion: In this study, factors were found that predicted discharge to skilled nursing facilities following hip fracture.

show abstract

“…h These diagnoses are frequently observed, often require post-hospital care and have been used in other studies [4,22]. Second, although the survey was administered to people living in the community and to those in nursing homes, we only use information from the community samples.…”

Section: Datamentioning

confidence: 99%

“…Kenney [3] demonstrates that the implementation of PPS reduced hospital stays and increased post-hospital use of HHA benefits. Morrisey et al [4] conclude that the probability of transfers from hospital to post-hospital care rose after prospective payment, especially to SNFs, for individuals in five major diagnostic groups. The reduction of hospital length-of-stay in their study was not statistically significant.…”

Section: Introductionmentioning

confidence: 99%

Analysis of hospital length of stay and discharge destination using hazard functions with unmeasured heterogeneity

Picone

Wilson

2003

Health Economics

View full text Add to dashboard Cite

The hospital length-of-stay and the discharge destination of a Medicare patient are the outcomes of one decision process involving the interests of the patient, the hospital, and the firms offering covered post-hospital care. We use a competing risk hazard estimation procedure and adjust for unobserved heterogeneity with a non-parametric technique to identify significant factors in the decision process. A patient's health and socio-economic characteristics, the availability of informal care, local market area conditions, and Medicare policies influence length-of-stay and discharge destination. The substitution we find between hospital and post-hospital care and among post-hospital care alternatives has policy implications for Medicare.

show abstract

Medicare Prospective Payment and Posthospital Transfers to Subacute Care

Cited by 57 publications

References 8 publications

Did the 1997 Balanced Budget Act Reduce Use of Physical and Occupational Therapy Services?

Did the 1997 Balanced Budget Act Reduce Use of Physical and Occupational Therapy Services?

Predictors of Discharge to a Skilled Nursing Facility following Hip Fracture Surgery in New York State

Analysis of hospital length of stay and discharge destination using hazard functions with unmeasured heterogeneity

Contact Info

Product

Resources

About