Study: PPS delay needed
A George Washington University study shows home heath agencies have reduced the amount of care to patients in the last half of the 1990s, prompting home care advocates to renew their claims that further reductions in Medicare payments will only hurt the industry further.
"This is the first evidence of an imploding benefit," says Jim Pyles, counsel for Home Health Services and Staff Association. "The GW study shows that patients who need the care the most are simply going without because agencies are laying off staff."
The study, which was previewed by the Senate Permanent Committee on Investigations in September, concluded that Congress should postpone the 15% cut scheduled for Oct. 1, 2000, until definitive data on the effects if the reductions can be assessed.
It also found that the number of Medicare beneficiaries admitted to care as a percentage of all patients has declined 21% since 1996; and the 1998 Medicare revenue of those agencies studied has declined by 25%, compared to 1994 levels — the result of lower payments and reduced utilization.
The Balanced Budget Act of 1997 has resulted in efficiencies in the delivery of home care, says Barbara Markham Smith, the study’s lead author. The BBA has led to the rise of case management, higher levels of nursing supervision, and outcomes-oriented care, she says. But those same efficiencies have been accompanied by a host of disruptions, such as growing variation in regional health status characteristics from new payment methodology.
The bottom line, Smith says, is that sicker patients are being discharged earlier, not just in home care, but in other segments of the health care industry.
Other study findings include:
• The majority of agencies studied altered their case mix or practice patterns to conform utilization to reimbursement.
• Chronically ill patients may experience greater fragmentation of care or disruption in care because of payment changes.
• Administrative constraints on utilization may affect access to appropriate levels of home care by sicker beneficiaries.
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