The Influence of a Change in Medicare Reimbursement on the Effectiveness of Stage III or Greater Decubitus Ulcer Home Health Nursing Care

Abstract

This study was designed to describe and evaluate the influence of a change in a Medicare reimbursement on the effectiveness of home health nursing care for stage III or greater decubitus ulcer patients. This health policy originated from the Balanced Budget Act (BBA) of 1997 and took its full effect with initiation of the Prospective Payment System (PPS) on October 1, 2000. A quantitative quasi-experimental design used OASIS data from the state of Virginia to evaluate 555 stage III or greater decubitus ulcer patients, age 65 or older. Comparisons were investigated between pre-PPS, 2000, and post-PPS, 2001, outcomes related to reported ulcer healing, lengths of stay, and discharge disposition. Results demonstrated significant differences for the outcomes studied. In addition, sanitation, ulcer healing, and discharge disposition were linked as predictors for length of stay. Results demonstrated that PPS has affected nursing care effectiveness for stage III or greater decubitus ulcer home health patients.

The impact of home health length of stay and number of skilled nursing visits on hospitalization among medicare-reimbursed skilled home health beneficiaries

“…Number of visits. Implementation of the Home Health PPS was followed by a dramatic reduction in the number of visits (Eaton, 2005; United States General Accounting Office [GAO], 2000) and home health LOS (Anderson et al, 2005;Murkofsky, Phillips, McCarthy, Davis, & Hamel, 2003). In 1997, prior to the Home Health PPS, Medicare recipients received an average of 73 total visits per home health admission.…”

“…Madigan (2008) reported that 85% of home health beneficiaries with heart failure completed home health services within one episode, and less than 5% received more than one episode. Many patients were discharged from home health with unresolved issues related to wounds, cognition, behavioral and continence status, and demonstrated less improvement overall compared to patients who received home health services prior to implementation of the Home Health PPS (Eaton, 2005;Madigan, 2001;Schlenker, Powell, & Goodrich, 2005).…”

Stage‐related implications of community‐acquired pressure injuries for the acute medical inpatients

“…subcutaneous fat and connective tissue, stage-3), while muscle, tendon and bone-tissue are not exposed. When stage-2 and stage-3 PIs are managed in a timely fashion according to the appropriate standards of care, it is possible to effectively avoid the progression thereof to higher stages and improve the patient's outcome (Eaton, 2005;Kramer & Kearney, 2000;Palese et al, 2015).…”

“…subcutaneous fat and connective tissue, stage‐3), while muscle, tendon and bone‐tissue are not exposed. When stage‐2 and stage‐3 PIs are managed in a timely fashion according to the appropriate standards of care, it is possible to effectively avoid the progression thereof to higher stages and improve the patient's outcome (Eaton, 2005; Kramer & Kearney, 2000; Palese et al, 2015). These premises seem to be strengthened by our findings, which highlighted that stage‐2 and stage‐3 PIs indicated a mortality risk that is closer to stage‐1 than to stage‐4 or unstageable PIs.…”

Searching for the Intervention in Intervention Research Reports

“…Papers published in practical nursing journals and journals on nursing specialties such as oncology or critical care were excluded from the sample. Research briefs were excluded from the sample, as were studies on the effects of public policy changes such as Medicare reimbursement on patient outcomes (e.g., see Eaton, 2005).…”