Changes in Regional Variation of Medicare Home Health Care Utilization and Service Mix for Patients Undergoing Major Orthopedic Procedures in Response to Changes in Reimbursement Policy
Changes in Regional Variation of Medicare Home Health Care Utilization and Service Mix for Patients Undergoing Major Orthopedic Procedures in Response to Changes in Reimbursement Policy
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DOI：
10.1111/j.1475-6773.2009.00983.x
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发表时间：
2009-08-01
影响因子：
3.4
通讯作者：
Ettner, Susan L.
中科院分区：
文献类型：
--
作者：
FitzGerald, John D.;Boscardin, W. John;Ettner, Susan L.
背景已经记录了家庭健康(HH)服务在地区利用方面的显著差异。根据联邦医疗保险的家庭健康临时和预期支付系统，制定了旨在遏制支出增长和减少地区差异的报销政策。目的检查联邦医疗保险报销政策对卫生保健服务利用率和提供的卫生保健服务类型的地区差异的影响。研究设计我们假设，报销变化将减少卫生保健服务的地区差异，卫生保健机构将通过减少技能较低的卫生保健辅助就诊来应对，与物理治疗或护理访问相比，减少的比例不成比例。对1996年1月至2001年12月期间接受择期关节置换术(160万出院)或髋部骨折手术治疗(120万出院)的所有医疗保险受助者进行了100%的抽样调查。结果在报销变化之前，选择HH的概率和HH的就诊次数在不同地区之间存在很大差异。由于费用偿还的变化，虽然卫生保健服务的使用概率变化不大，但卫生保健服务的访问次数和变化明显减少，基线利用率最高的区域减少幅度最大。卫生保健助理就诊是基线变化的来源，也是实施后使用率下降的主要原因。结论卫生保健临时和预期付费政策有效地减少了卫生保健利用的地区差异。
BackgroundSignificant variation in regional utilization of home health (HH) services has been documented. Under Medicare's Home Health Interim and Prospective Payment Systems, reimbursement policies designed to curb expenditure growth and reduce regional variation were instituted.ObjectiveTo examine the impact of Medicare reimbursement policy on regional variation in HH care utilization and type of HH services delivered.Research DesignWe postulated that the reimbursement changes would reduce regional variation in HH services and that HH agencies would respond by reducing less skilled HH aide visits disproportionately compared with physical therapy or nursing visits. An interrupted time-series analysis was conducted to examine regional variation in the month-to-month probability of HH selection, and the number of and type of visits among HH users.SubjectsA 100 percent sample of all Medicare recipients undergoing either elective joint replacement (1.6 million hospital discharges) or surgical management of hip fracture (1.2 million hospital discharges) between January 1996 and December 2001 was selected.ResultsBefore the reimbursement changes, there was great variability in the probability of HH selection and the number of HH visits provided across regions. In response to the reimbursement changes, though there was little change in the variation of probability of HH utilization, there were marked reductions in the number and variation of HH visits, with greatest reductions in regions with highest baseline utilization. HH aide visits were the source of the baseline variation and accounted for the majority of the reductions in utilization after implementation.ConclusionsThe HH interim and prospective payment policies were effective in reducing regional variation in HH utilization.