Medicare per episode prospective payment : a system with no apparent shifts in cost or burden

195 Pages·2000·6.3 MB·English

by  Phillips, Barbara

ContractNo.: 500-94-0062
MPRReferenceNo.: 8246-125
MedicarePerEpisode
ProspectivePayment: A
SystemwithNoApparent
ShiftsinCostorBurden
June8,2000
Ba ps
Vet. .irsSanDiegoHealthCareSystem
Universii_yofCalifornia,SanDiego
Programmers:
ElizabethStuart
MathematicaPolicyResearch,Inc.
AmyZambrowski
MathematicaPolicyResearch,Inc.
SurveyDirector:
RhodaCohen
MathematicaPolicyResearch,Inc.
Submittedto: Submittedby:
HealthCareFinancingAdministration MathematicaPolicyResearch,Inc.
7500SecurityBlvd,(C-3-21-06) P.O.Box2393
Baltimore,MD 21244-1850 Princeton,NJ 08543-2393
[phone]
ProjectOfficer: ProjectDirector:
AnnMeadow ValerieCheh
PrincipalInvestigators:
ValerieCheh
RandallBrown
BarbaraPhillips

..
CONTENTS
Chapter Page
EXECUTIVESUMMARY xi
I THEPER-EPISODEHOMEHEALTHDEMONSTRATIONAND
EVALUATION 1
A. THEMEDICAREHOMEHEALTHBENEFIT 2
B. THEPER-EPISODEDEMONSTRATION 4
1 DemonstrationPaymentandIncentives 6
2. OtherDemonstrationProcedures 9
n MECHANISMS,STRATEGIES,ANDIMPACTSONHOME
HEALTHUSE 13
A. MECHANISMS 13
B. AGENCYSTRATEGIES 15
C. IMPACTOFPER-EPISODEPAYMENTONHOMEHEALTH
SERVICES 16
D. EXPECTEDIMPACTONTHEUSEOFNON-MEDICARE
SERVICES 17
III DATAANDVARIABLES 19
A. THEPATIENTSURVEY 19
B. VARIABLES 21
1 OutcomeVariables 21
2. ControlVariables 25
ni
...
CONTENTS(continued)
Chapter Page
IV METHODS 37
A. STATISTICALTECHNIQUES 37
1. ModelsforEstimatingOverallImpacts 38
2. EstimatingSubgroupImpacts 40
B. WEIGHTINGANDDESIGNEFFECTS 42
1 Weighting 42
2. AdjustingfortheDesignEffect 44
C. SAMPLES 47
D. HYPOTHESISTESTSFORTHEIMPACTESTIMATES 47
V OVERALLIMPACTS 49
A. IMPACTSONINFORMALCARE 49
1 LikelihoodofReceivingInformalCare 49
2. AmountofInformalCare 55
3. SensitivitytoSample 55
4. Discussion 57
B. IMPACTSONHOME-BASEDANDCOMMUNITY-
BASEDSERVICES 59
1. Results 59
2. Discussion 66
C. IMPACTSONRESIDENTIALSERVICES 67
1 LikelihoodofResidenceinanAssisted-LivingFacility 67
2. NursingHomeServices 72
3. Discussion 75
IV
..
CONTENTS(continued)
Chapter P«g«
VI SUBGROUPIMPACTS 81
A. SUBGROUPDEFINITIONS 82
1 AgencyCharacteristics °2
2. PatientCharacteristics 84
B. ESTIMATEDDIFFERENCESFORAGENCYSUBGROUPS 85
C. IMPACTSFORPATIENTSUBGROUP: MEDICAID
RECIPIENTS 89
1. InformalCare 89
2. Home-BasedandCommunity-BasedServices 99
3. ResidentialServices ^^"
D. DISCUSSION 112
1 InformalCare 11^
2. Home-DeliveredMeals 11^
3. ResidentialServices 11^
VII CONCLUSIONS 119
A. SUMMARYOFRESULTS 119
1. OverallResults 119
2. DifferentialImpactsbyPatientandAgencyCharacteristics 120
B. LIMITATIONSOFTHISANALYSIS 121
C. POLICYIMPLICATIONS 123
REFERENCES 125
APPENDIXA: ILLUSTRATIVEQUESTIONSFROM
THEFOUR-ANDEIGHT-MONTH
INTERVIEWSONUSEOFNON-MEDICARE
SERVICES 127
CONTENTS(continued)
Chapter Page
APPENDIXB: DESIGNANDFIELDINGOF
THEPATIENTSURVEY ... 155
APPENDIXC: SUPPLEMENTALTABLESFOR
CHAPTERVI 167
VI
TABLES
Table Page
III.1 EPISODE-LEVELCONTROLVARIABLESFORMULTIVARIATE
ANALYSIS,BYSOURCE 28
111.2 AGENCY-ANDAREA-LEVELCONTROLVARIABLESFOR
MULTIVARIATEANALYSES,BYSOURCE 29
111.3 WEIGHTEDMEANSFORCONTROLVARIABLES,BY
TREATMENTSTATUS 32
V.1 THEIMPACTOFPER-EPISODEPAYMENTONTHEUSEOF
INFORMALCAREATFOURMONTHS 51
V.2 THEIMPACTOFPER-EPISODEPAYMENTONTHEUSEOF
INFORMALCAREATFOURMONTHS 52
V.3 THEIMPACTOFPER-EPISODEPAYMENTONTHEUSEOF
INFORMALCAREATEIGHTMONTHS 53
V.4 THEIMPACTOFPER-EPISODEPAYMENTONTHEUSEOF
INFORMALCAREATEIGHTMONTHS 54
V.5 THEIMPACTOFPER-EPISODEPAYMENTONTHEUSEOF
HOME-BASEDANDCOMMUNITY-BASEDNON-MEDICARE
SERVICESATFOURMONTHS 60
V.6 THEIMPACTOFPER-EPISODEPAYMENTONTHEUSEOF
HOME-BASEDANDCOMMUNITY-BASEDNON-MEDICARE
SERVICESATFOURMONTHS 61
V.7 THEIMPACTOFPER-EPISODEPAYMENTONTHEUSEOF
HOME-BASED ANDCOMMUNITY-BASEDNON-MEDICARE
SERVICESATEIGHTMONTHS 62
V.8 THEIMPACTOFPER-EPISODEPAYMENTONTHEUSEOF
HOME-BASEDANDCOMMUNITY-BASEDNON-MEDICARE
SERVICESATEIGHTMONTHS 65
V.9 THEIMPACTOFPER-EPISODEPAYMENTONTHEUSEOF
RESIDENTIAL NON-MEDICARESERVICESATFOURMONTHS 68
Vll
81
TABLES(continued)
Table Page
V.1 TOFHEREISMIPDAECNTTIOAFLPNEOR-NE-PMIESDOIDCEAPRAEYSMEERNVTICOENSTAHTEFUOSUERMONTHS 69
V.1 TOFHEREISMIPDAECNTTIOAFLPNEOR-NE-PMIESDOIDCEAPRAEYSMEERNVTICOENSTAHTEEUISGEHTMONTHS 71
V.12 THEIMPACTOFPER-EPISODEPAYMENTONTHEUSEOF
RESIDENTIAL NON-MEDICARESERVICESATEIGHTMONTHS 74
VI.1 DEPENDENTVARIABLESFORAGENCYSUBGROUPANALYSES 87
VI.2 IMPACTOFPER-EPISODEPAYMENTONTHEUSEOFINFORMAL
CAREATFOURMONTHS,BYPATIENT'SMEDICAIDSTATUS 90
VI.3 IMPACTOFPER-EPISODEPAYMENTONTHEUSEOFINFORMAL
CARE ATEIGHTMONTHS,BYPATIENT'SMEDICAIDSTATUS 93
VI.4 IMPACTOFPER-EPISODEPAYMENTONTHEUSEOFINFORMAL
CARE ATEIGHTMONTHS,BYPATIENT'SMEDICAIDSTATUS 96
VI.5 ESTIMATEDTREATMENT-CONTROLDIFFERENCESFOR
LIKELIHOODOF RECEIPTOFINFORMALCAREATEIGHT
MONTHS,BYPATIENT'SMEDICAIDSTATUSANDWEIGHTING
SCHEME 98
VI.6 IMPACTOFPER-EPISODEPAYMENTONTHEUSEOFFORMAL,
NON-RESIDENTIALNON-MEDICARESERVICESATFOUR
MONTHS,BYPATIENT'SMEDICAIDSTATUS 100
VI.7 IMPACTOFPER-EPISODEPAYMENTONTHEUSEOFFORMAL,
NON-RESIDENTIAL,NON-MEDICARESERVICESATEIGHT
MONTHS,BYPATIENT'SMEDICAIDSTATUS 102
VI. IMPACTOFPER-EPISODEPAYMENTONTHEUSEOF
RESIDENTIALSERVICESATFOURMONTHS,BYPATIENT'S
MEDICAIDSTATUS 107
VI.9 IMPACTOFPER-EPISODEPAYMENTONTHEUSEOF
RESIDENTIALSERVICESTOEIGHTMONTHS,BYPATIENT'S
MEDICAIDSTATUS 109
viu
FIGURES
Figure Page
V.1 MEANINFORMALCAREGIVERVISITS,TWOWEEKSBEFORE
INTERVIEW 56
V.2 MEANNON-MEDICAREHOMEMAKERVISITS,TWOWEEKS
BEFOREINTERVIEW 64
V.3 MEANNURSINGHOMEDAYSDURINGFOUR-MONTHPERIOD 76
IX