Data from new study show reimbursement trends
The study isn't cheap, so we give you the findings
The new health care study covered in the March issue of Hospital Home Health is expensive to buy -- around $300 -- but the few pages of information it contains on home care are valuable. The whole study is available for purchase this month.
Dartmouth Medical School in Hanover, NH, which conducted "The Dartmouth Atlas of Health Care" study, has allowed HHH to print the study's findings on home care here in case you can't afford to buy the whole study.
The rest of the study, which details all types of Medicare usage in markets all across the United States, is quite interesting, so do consider purchasing it. (See the end of this article for ordering information.)
Here are the study's findings on home care:
* In 1993, price-adjusted Medicare reimbursements for home health care services for enrollees over age 65 paid for on a fee-for-service basis totaled $9.24 billion, or $313 per enrollee. These reimbursements represented 8% of traditional Medicare program outlays.
* Variations in the levels of Medicare reimbursements for home health care were extreme. The highest price-adjusted reimbursement rate per Medicare enrollee, in Chattanooga, TN, ($1,292), was 25 times higher than that in Rochester, MN, which had the lowest rate ($51). (See map, p. 44.)
High per capita rates
* The per capita reimbursement for Medicare enrollees in the Chattanooga hospital referral region was 25% higher than in the next-highest region, Baton Rouge, LA ($1,032). Other parts of Tennessee, including Knoxville ($975), Nashville ($966), Jackson ($856), Johnson City ($629), and Memphis ($574) also were high.
* Other parts of the South also had high per enrollee home health reimbursements including Jackson, MS ($710), New Orleans ($700), Miami ($612), Birmingham, AL ($550), and Orlando, FL ($543).
Low per capita rates
* Among the hospital regions with the lowest per capita rates of reimbursement were Minneapolis ($102), Wichita, KS ($124), White Plains, NY ($130), Hackensack, NJ ($136), Honolulu ($149), Morristown, NJ ($140), and Richmond, VA ($162).
* It has often been proposed that overall expenditures for health care can be reduced by substituting less costly care, such as hospital outpatient services and home health care, for more costly hospital inpatient care. It also has been suggested that reimbursements for physicians' services might be lower in regions with greater use of home health care services. Others theorize that regions with relatively scarce per capita investment in physician services have higher costs for hospital care. The documented patterns of variation in reimbursements for Medicare services provide no evidence that any of these types of substitutions are occurring.
* Greater reimbursements for home health agency services were not associated with lower physician reimbursements. Indeed, there was a weak association in the opposite direction indicating that there may be some relationship between higher rates of use of physicians' services and higher rates of use of home health care services.
The "The Dartmouth Atlas of Health Care" is an analysis of nationwide Medicare data from 1993, conducted by John E. Wennberg, MD, MPH, physician and epidemiologist at Dartmouth Medical School in Hanover, NH, and the director of Dartmouth's Center for the Evaluative Clinical Sciences.
To order the study, call the American Hospital Association at (800) 242-2626. The catalog number of the study is 044100. *
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