Medicare Prospective Payment Before and After Implementation

Abstract

This retrospective case study examined whether the Medicare Prospective Payment System affected the number of visits and physical performance among Medicare home health patients after total knee replacements. Post-Prospective Payment System significant results included fewer visits, less improvement in knee extension range of motion, and increased ambulation distances at discharge.

In-home care following total knee replacement

“…By paying for care based on the entire episode, CMS believes it can encourage more rational allocation of resources along the care path. 9 It is widely recognized that one area where care can be better managed is during the transitions that occur at many points along the care path-for example, transition from operating theater to postoperative unit and then to the acute care hospital setting, and transition from acute care hospital to a postacute setting. 1,4,10 When a patient no longer requires hospital services but needs the benefits of continued care, the transition to postacute care must be managed carefully.…”