This project aimed to study the direct and indirect
effects of changes in Medicare home health policy, the Interim
Payment Systi (IPS), mandated by the Balanced Budget Act (BBA)
of 1997. It used data on Medicare home health beneficiaries
and agencies from two time periods, pre- and post-BBA implientation.
The study explored the following questions:
| 1.) |
What is the impact of the BBA on beneficiaries?, |
| 2.) |
What is the impact of the BBA on agency
behavior?, and |
| 3.) |
What is the impact of the BBA on the overall
systi? |
Use of Medicare home health service changed markedly.
When comparing service use in FY 1997 with service use in
FY 1999, the investigators found considerable declines. Visits
were more likely to be skilled rather than unskilled, and
episodes of care were likely to be shorter.
With a few exceptions, it appears that the IPS had
a limited impact on beneficiaries. The study was
unable to find consistent effects of the IPS on the incidence
of adverse outcomes. It did find, however, that patients’
functional status was not harmed. On most measures, patient
satisfaction did not change, although it declined for some
measures of interpersonal interaction with staff. In addition,
there were significant decreases in quality of life: Medicare
beneficiaries were less satisfied with their lives, and disabled
beneficiaries were less satisfied with their personal care
arrangients.
Few systis changes were identified. There
was no evidence of an increase in aggregate state expenditures
on Medicaid home and community-based services corresponding
to a state-level decrease in Medicare home health spending.
While there was a decline in the use of Medicare home health
following hospital stays for selected conditions, little shifting
was found from home health care to other types of post-acute
care (such as rehabilitation and skilled nursing facilities).
Lastly, no patterns of adverse outcomes were seen for selected
post-acute diagnostic groups, although there was some evidence
of increased mortality.
These findings suggest that the financial incentives instituted
by the BBA had b effects on provider behavior. In addition,
it appears that changes in provider behavior increased home
health care agencies’ efficiency without causing harm
to program beneficiaries.
Publications
Ahrens J (based on the work of Chris M. Murtaugh, Nelda McCall,
Stanley Moore, and Ann Meadow). 2005.
Research Brief, no. 19: The Impact of Medicare
Home Health Policy Changes on Medicare Beneficiaries: Part
II.
NY: Home Care Research Initiative, The Center for Home
Care Policy and Research, Visiting Nurse Service of New York.
Murtaugh, C., McCall, N., Moore, S., and Meadow, A. 2003.
“Trends in Medicare home health care use: 1997-2001.”
Health Affairs, 22(5): 146-156.
McCall, N. and Korb, J. 2003.
Policy Brief: The Impact of Medicare Home
Health Policy Changes on Medicare Beneficiaries.
NY: Home Care Research Initiative, The Center for Home
Care Policy and Research, Visiting Nurse Service of New York.
McCall, N. and Korb, J. 2003.
Fact Sheet: Medicare Home Health Use after
the 1997 BBA.
NY: Home Care Research Initiative, The Center for Home
Care Policy and Research, Visiting Nurse Service of New York.
McCall, N., Petersons, A., Moore, S., and Korb, J. 2002.
"Utilization of Home Health Services Before and After
The BBA of 1997: What Were the Initial Effects?"
Health Services Research, forthcoming.
McCall, N., Komisar, H., Petersons, A., and Moore, S. 2001.
"Medicare Home Health Before and After the BBA."
Health Affairs (20) 3:189-198.
Reports
Cheh V and Black W. May 2002.
Did the Balanced Budget Agreient of 1997 Affect the Quality
of Medicare Home Health Services?
Princeton, NJ: Mathiatica Policy Research, Inc.
Laguna Research Associates. May 2002.
Final Report: Direct and Indirect Effects of the Changes
in Home Health Policy as Mandated by the Balanced Budget Act
of 1997
San Francisco, CA: Laguna Research Associates.
McCall, N., Petersons, A., Moore, S., and Korb, J. February
2002.
Utilization of Home Health Services Before and After
The BBA of 1997: What Were the Initial Effects?
San Francisco, CA: Laguna Research Associates.
McCall, N., Korb, J., Petersons, A. and Moore, S. April 2002.
Constraining Medicare Home Health Reimbursient: What
Are the Outcomes?
San Francisco, CA: Laguna Research Associates.
McCall, N., Korb, J., Petersons, A. and Moore, S. April 2002.
Decreased Home Health Use: Does It Decrease Satisfaction?
San Francisco, CA: Laguna Research Associates.
McCall, N., Korb, J., Petersons, A. and Moore, S. May 2002.
Has Post-Acute Care Changed After the BBA of 1997?
San Francisco, CA: Laguna Research Associates.
McCall, N., Korb, J., Petersons, A., and Moore, S. May 2002.
Study of the Impact of Monitoring the Health Outcomes
for Disabled.
San Francisco, CA: Laguna Research Associates.
Rogers, S., and Komisar, H. May 2002.
Effects of the Balanced Budget Act on Medicare Home
Health Agencies, Services, and Clients: Findings From Interviews
With Home Care Associations and Agencies.
Washington D.C.: Institute for Health Care Research and
Policy, Georgetown University.
Komisar, H. May 2002.
Rolling Back Medicare Home Health: The Effects of
the Balanced Budget Act on Patterns of Use and Visit Mix.
Washington D.C.: Institute for Health Care Research and
Policy, Georgetown University.
McCall, N., Komisar, H., Petersons, A., and Moore, S. January
2000.
"Medicare Home Health Before and After the BBA."
San Francisco, CA: Laguna Research Associates.
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