Impact of the BBA on post-acute utilization.
PubMedPublished 1 January 1999Open access
Barbara Gage
Citations72
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
The author describes new post-acute care (PAC) payment policies, service patterns prior to the Balanced Budget Act of 1997 (BBA), differences in the populations using these providers, and possible effects of the new payment systems on site-of-care decisions.
Abstract
In this article, the author summarizes recent changes in Medicare post-acute payment policies, discusses the implications of certain design and implementation issues, and analyzes whether different types of patients are using skilled nursing facilities (SNFs), home health agencies (HHAs), and rehabilitation hospitals and units. If similar populations are treated by these three types of providers, service patterns may be affected by the financial incentives in the new, more restrictive payment policies. The author describes new post-acute care (PAC) payment policies, service patterns prior to the Balanced Budget Act of 1997 (BBA), differences in the populations using these providers, and possible effects of the new payment systems on site-of-care decisions.
Keywords
Health ProfessionsEconomics, Econometrics and Finance
Cambridge University Press eBooksLimited-dependent and qualitative variables in econometrics
13,454 Citations1983G. S. Maddala
Medical CareRefining a Case-Mix Measure for Nursing Homes: Resource Utilization Groups (RUG-III)
551 Citations1994Brant E. Fries, D. P. Schneider +4 more
A case-mix classification system for nursing home residents is developed, based on a sample of 7,658 residents in seven states, which achieves 55.5% variance explanation of total (nursing and therapy) per diem cost and meets goals of clinical validity and payment incentives.
PubMedOutcomes and costs after hip fracture and stroke. A comparison of rehabilitation settings.
311 Citations1997Andrew M. Kramer, John F. Steiner +6 more
Journal of the American Geriatrics SocietyFunctional Outcomes of Posthospital Care for Stroke and Hip Fracture Patients Under Medicare
117 Citations1998Robert L Kane, Qing Chen +4 more
This study analyzed the outcomes of different types of posthospital care for a cohort of older Medicare patients (who had diagnoses associated with the use of a range of post hospital care modalities) for up to a year after hospital discharge.
PubMedThe first 3 years of Medicare prospective payment: an overview.
91 Citations1988Stuart Guterman, Paul W. Eggers +3 more
The impact of PPS on hospitals, Medicare beneficiaries, post-hospital care, other payers for inpatient hospital services, other health care providers, and Medicare program operations and expenditures is examined.
New England Journal of MedicineThe Effect of Medicare's Payment System for Rehabilitation Hospitals on Length of Stay, Charges, and Total Payments
90 Citations1997Leighton Chan, Thomas D. Koepsell +5 more
Although Medicare's reimbursement system for rehabilitation hospitals put an upper limit on total payments, its design was associated with substantial extra costs, including significantly increased payments to hospitals and doctors and increased numbers of hospital days for the average patient.
Journal of the American Geriatrics SocietyUse of Post‐Hospital Care by Medicare Patients
75 Citations1996Robert L Kane, Michael Finch +4 more
The characteristics of patients, cities, and hospitals associated with discharge to these different types of post‐hospital care are examined.
PubMedDevelopment of function-related groups version 2.0: a classification system for medical rehabilitation.
68 Citations1997Margaret G. Stineman, Charles J. Tassoni +5 more
FIM-FRGs Version 2.0 includes more specific impairment categories, classifies a higher percentage of patient discharges, and appears sufficiently stable over time to form the basis of a payment system for inpatient medical rehabilitation.
PubMedFactors contributing to practice variation in post-stroke rehabilitation.
43 Citations1997A J Lee, Juliusz Huber +1 more
A substantial portion of inter-MSA variability in utilization and intensity of post-stroke rehabilitation services cannot be explained by differences in patient characteristics, given the large practice differences observed across MSAs.
Medical CareApplication of Functional Independence Measure-Function Related Groups and Resource Utilization Groups-Version III Systems Across Post Acute Settings
28 Citations1998Theresa B. Eilertsen, Andrew M. Kramer +2 more
The FIM-FRGs are valid for resource use as well as length of stay for rehabilitation facility patients, but are not valid for skilled nursing facility patients and the Resource Utilization Groups-Version III system does not apply to rehabilitation facility Patients.
PubMedDeterminants and costs of Medicare post-acute care provided by SNFs and HHAs.
23 Citations1998Korbin Liu, D Wissoker +1 more
Data from the Medicare Current Beneficiary Survey is used to shed light on responses that need to be monitored in light of the recently mandated policies and other SNF and HHA options that are being considered.
PubMedCost-effectiveness implications based on a comparison of nursing home and home health case mix.
19 Citations1985Andrew M. Kramer, Peter W. Shaughnessy +1 more
It would appear that home health care might provide a substitute for acute care hospital use at the end of a hospital stay, and appears to be a more viable option in the care of patients who are not severely disabled and do not have profound functional problems.
PubMedMedicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1999 rates--HCFA. Final rule.
11 Citations1998
The Medicare hospital inpatient prospective payment systems for operating costs and capital-related costs are revising to implement applicable statutory requirements, including section 4407 of the Balanced Budget Act of 1997 (BBA), as well as changes arising from the continuing experience with the systems.
PubMedDo preset per visit payment rates affect home health agency behavior?
9 Citations1994Barbara Phillips, Randall Brown +6 more
Preliminary impacts during the first year of a demonstration in which home health agencies were paid a prospectively set rate for each Medicare home health visit rendered found no compelling evidence of any demonstration impact on agency cost per visit, the volume of home health services, agency revenue and profit, patient selection and retention, quality of care, or use of Medicare services.