Understanding the State Variation in Medicare Home Health Care

Cohen, Marc A.; Tumlinson, Anne

doi:10.1097/00005650-199706000-00007

Cited by 50 publications

(15 citation statements)

References 4 publications

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“…Prior research suggests that the overlap of Medicare and Medicaid and other state programs gives states an opportunity to substitute Medicare for state home-care dollars (Cohen & Tumlinson, 1997). The recent BBA policy changes have led to reduced Medicare funding of home care.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Rural Location on Utilization of Formal Home Care: The Role of Medicaid

McAuley

Spector²,

Nostrand³

et al. 2004

The Gerontologist

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Section: Discussionmentioning

confidence: 99%

The Influence of Rural Location on Utilization of Formal Home Care: The Role of Medicaid

McAuley

Spector²,

Nostrand³

et al. 2004

The Gerontologist

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“…This change is due in large part to legal and administrative changes (Vladeck & Miller, 1994). Some suggest that states, in an effort to replace Medicaidfunded home care with Medicare-funded home care, engaged in so-called Medicare maximization (Cohen & Tumlinson, 1997;Kenney, Rajan, & Soscia, 1998;Wiener & Stevenson, 1998), reducing Medicaid long-term care expenditures.…”

Section: Variablesmentioning

confidence: 99%

Access to Community-Based Long-Term Care

2002

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“…Although Medicare PAC eligibility criteria are codified in regulations, as a practical matter PAC providers, physicians, and hospital 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; Kane et al 1996; Schore 1996; Cohen and Tumlinson 1997; Kane, Lin, and Blewett 2002; MedPAC 2003).…”

mentioning

confidence: 99%

How Much Is Postacute Care Use Affected by Its Availability?

Buntin¹,

Garten²,

Paddock³

et al. 2005

Health Services Research

124

109

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Objective. To assess the relative impact of clinical factors versus nonclinical factors--such as postacute care (PAC) supply--in determining whether patients receive care from skilled nursing facilities (SNFs) or inpatient rehabilitation facilities (IRFs) after discharge from acute care. Data Sources and Study Setting. Medicare acute hospital, IRF, and SNF claims provided data on PAC choices; predictors of site of PAC chosen were generated from Medicare claims, provider of services, enrollment file, and Area Resource File data. Study Design. We used multinomial logit models to predict PAC use by elderly patients after hospitalizations for stroke, hip fractures, or lower extremity joint replacements. Data Collection/Extraction Methods. A file was constructed linking acute and postacute utilization data for all medicare patients hospitalized in 1999. Principal Findings. PAC availability is a more powerful predictor of PAC use than the clinical characteristics in many of our models. The effects of distance to providers and supply of providers are particularly clear in the choice between IRF and SNF care. The farther away the nearest IRF is, and the closer the nearest SNF is, the less likely a patient is to go to an IRF. Similarly, the fewer IRFs, and the more SNFs, there are in the patient's area the less likely the patient is to go to an IRF. In addition, if the hospital from which the patient is discharged has a related IRF or a related SNF the patient is more likely to go there. Conclusions. We find that the availability of PAC is a major determinant of whether patients use such care and which type of PAC facility they use. Further research is needed in order to evaluate whether these findings indicate that a greater supply of PAC leads to both higher use of institutional care and better outcomes--or whether it leads to unwarranted expenditures of resources and delays in returning patients to their homes.Key Words. postacute care, provider supply, Medicare, rehabilatation, nursing homes Postacute care (PAC) was the fastest growing sector of the Medicare program throughout the early to mid-1990s. A number of factors including payment incentives, advances in drug treatments and surgical techniques, and improvements in outpatient care contributed to shorter lengths of stay in acute care hospitals and corresponding increases in PAC use. As more hospitalized patients transfer to PAC, the need to better understand the factors driving such transfers is growing. 413

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Understanding the State Variation in Medicare Home Health Care

Cited by 50 publications

References 4 publications

The Influence of Rural Location on Utilization of Formal Home Care: The Role of Medicaid

The Influence of Rural Location on Utilization of Formal Home Care: The Role of Medicaid

Access to Community-Based Long-Term Care

How Much Is Postacute Care Use Affected by Its Availability?

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