The impact of home health prospective payment on Medicare service use and reimbursement

177 Pages·2000·6.6 MB·English

by  Schore, Jennifer

ContractNo.: 500-94-0062
MPRReferenceNo.: 8246-124
TheImpactofHome
HealthProspective
PaymentonMedicare
ServiceUseand
Reimbursement
December2000
Author:
JenniferSchore
Programmers:
ElizabethStuart
RobertWild
AmyZambrowski
Submittedto: Submittedby:
HealthCareFinancingAdministration MathematicaPolicyResearch,Inc.
7500SecurityBoulevard(C-3-21-06) P.O.Box2393
Baltimore,MD21244-1850 Princeton,NJ 08543-2393
[phone]
ProjectOfficer: ProjectDirector:
AnnMeadow ValerieCheh
PrincipalInvestigator:
RandallBrown
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ACKNOWLEDGMENTS
InpreparingthisreportI receivedtheassistanceand supportofanumberofmy MPR
colleagues,forwhichIamgrateful. ChrisTrenholm,RandyBrown,andValerieChehprovided
criticalreviewofthereport. EarlierworkdoneonthisprojectbyValerieCheh,BarbaraPhillips,
andChrisTrenholmisembodiedinthisreport'sbackgroundchapters. MarjorieMitchellproduced
thereportwiththeassistanceofDeniseDunnandGloriaGustus,andPatriciaCiaccioprovided
editorialassistance. AnnMeadowofHCFAprovidedinsightfulcommentsonanearlierdraftofthe
report. If,afterallthishelp,therearestillerrorsinthereport,theresponsibilityforthemismine.
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CONTENTS
Chapter Page
EXECUTIVESUMMARY xiii
THEPER-EPISODEHOMEHEALTHDEMONSTRATIONAND
I
EVALUATION 1
A. THEMEDICAREHOMEHEALTHBENEFIT 2
B. THEPER-EPISODEDEMONSTRATION 4
1. DemonstrationPaymentandIncentives 6
2. OtherDemonstrationProcedures 9
C. HYPOTHESESCONCERNINGTHEEFFECTOFPER-EPISODE
PAYMENTONTHEUSEANDCOSTOFMEDICARE
SERVICES 12
D„GUIDETOTHERESTOFTHISREPORTANDOTHER
EVALUATIONREPORTS 14
II DATA 17
A CONSTRUCTINGTHEMAINDATAFILE 18
1. IdentifyingIndividualPatientEpisodes 19
2. CreatingOutcomeVariables 20
3. CreatingControlVariables 22
B. FORMINGTHEANALYSISSAMPLE 29
1. ExcludingAgencies 30
2. ExcludingPatients 30
3. AnalysisSamples 31
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CONTENTS(continued)
Chapter Page
II C. PATIENTSANDAGENCIESINTHEMAINANALYSIS
(continued) SAMPLE 32
1. PatientCharacteristicsfortheMainAnalysisSample 34
2. PatientCharacteristicsfortheQualityAssuranceSubsample 42
3. AgencyandAreaCharacteristicsfortheMainAnalysisSample 43
4. ImplicationsfortheAnalysisofProgramImpacts 47
III METHODS 49
A. REFERENCEPERIODS 49
1. WhyInvestigatingImpactsOveraPatientEpisodeIs
Problematic 50
2. The"Patient-Year"asPrimaryReferencePeriod 50
B. STATISTICALTECHNIQUES 52
1. OverallImpactEstimates 54
2. HypothesisTests 56
3. SubgroupImpacts 57
4. DifferencesinImpactsBetweenDemonstrationYears 60
5. Weighting 62
6. DesignEffects 63
7. RobustnessofImpactEstimates 63
IV OVERALLIMPACTSONTHEUSEOFANDREIMBURSEMENT
FORMEDICARE-COVEREDSERVICES 69
A. EMERGENCYROOMANDINPATIENTSERVICES 69
B. SKILLEDNURSINGFACILITYANDHOSPICESERVICES 76
C. NONDEMONSTRATIONHOMEHEALTHANDALLPARTB
HOMEHEALTHSERVICES 79
D. PARTBSERVICES 85
E. TOTALMEDICAREREIMBURSEMENT 88
SUMMARY
F. 91
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CONTENTS(continued)
Chapter Page
V SUBGROUPIMPACTSONTHEUSEOFAND
REIMBURSEMENTFORMEDICARE-COVERED
SERVICES 93
A. HYPOTHESESCONCERNINGSUBGROUPIMPACTS 94
B. SUBGROUPIMPACTESTIMATES 96
21.. ESkmielrlgedenNcurysRinogoFmacEinlcitoyunatnedrsNoannddemIonpnasttireanttiAodnmiHsosmioensHealth 98
Admissions 101
3. MedicarePartAandPartBReimbursement 104
C. CONCLUSION 107
VI CONCLUSIONS Ill
A. FINDINGS Ill
B. LIMITATIONS 113
C. SUMMARY 115
REFERENCES 117
APPENDIXA: ESTIMATEDDIFFERENCESBETWEENPER-EPISODE
PAYMENTANDCOSTREIMBURSEMENTDURING
DEMONSTRATIONYEAR2 119
APPENDIXB: ESTIMATEDDIFFERENCESBETWEENPER-EPISODE
PAYMENTANDCOSTREIMBURSEMENTINKEY
OUTCOMES,DURINGDEMONSTRATIONYEAR1,
BYSUBGROUP 131
APPENDIXC: ESTIMATEDCOEFFICIENTSFORKEYOUTCOMES
DURINGDEMONSTRATIONYEAR1 149
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I
TABLES
Table Pa8e
OUTCOMEVARIABLESDESCRIBINGMEDICARE-COVERED
II.1 SERVICEUSEANDREIMBURSEMENTDURINGTHEYEAR
FOLLOWINGDEMONSTRATIONEPISODESTART 21
11.2 CONTROLVARIABLESFORMULTIVARIATEANALYSIS,
BYSOURCE 23
11.3 NSEULMEBCETREDOFTIPMAETIPEENRTIOSDISN,TBHYEDAENMAOLNYSSITSRASTAIMOPNLEYECAORVEARNIDNG
TREATMENTSTATUS 33
11.4 WEIGHTEDMEANSFORSTANDARDPATIENT-SPECIFIC
CONTROLVARIABLES,BYTREATMENTSTATUSFOR
DEMONSTRATIONYEAR1 35
11.5 WEIGHTEDMEANSFORLAGGEDDEPENDENTVARIABLES,
BYTREATMENTSTATUSFORDEMONSTRATIONYEAR1 39
11.6 WEIGHTEDMEANSFORSUPPLEMENTALPATIENT-SPECIFIC
CONTROLVARIABLESFROMQADATA,BYTREATMENT
STATUSFORDEMONSTRATIONYEAR1 44
11.7 ' WEIGHTEDMEANSFORSTANDARDAGENCY-AND
AREA-SPECIFICCONTROLVARIABLES,BYTREATMENT
STATUSFORDEMONSTRATIONYEAR1 46
IV.1 EASNTDICMOASTTEDREDIIFMFBEURRESNECMEESNBTEITNWEEMEENRPGEERN-ECPYISROODOEMPAUSYEMENT
DURINGDEMONSTRATIONYEAR1 72
IV.2 ESTIMATEDDIFFERENCESBETWEENPER-EPISODEPAYMENT
ANDCOSTREIMBURSEMENTININPATIENTHOSPITALUSE
ANDREIMBURSEMENTDURINGDEMONSTRATIONYEAR1 74
IV.3 ESTIMATEDDIFFERENCESBETWEENPER-EPISODEPAYMENT
ANDCOSTREIMBURSEMENTINSKILLEDNURSINGFACILITY
ANDHOSPICEUSEANDREIMBURSEMENTDURING
DEMONSTRATIONYEAR1 77
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'
TABLES(continued)
Table Page
IV.4 ESTIMATEDDIFFERENCESBETWEENPER-EPISODEPAYMENT
ANDCOSTREIMBURSEMENTIN NONDEMONSTRATION
HOMEHEALTHUSEANDREIMBURSEMENTDURING
DEMONSTRATIONYEAR1 81
IV.5 ESTIMATEDDIFFERENCESBETWEENPER-EPISODEPAYMENT
ANDCOSTREIMBURSEMENT INPARTBUSEAND
REIMBURSEMENTDURINGDEMONSTRATIONYEAR1 86
IV.6 ESTIMATEDDIFFERENCESBETWEENPER-EPISODEPAYMENT
ANDCOSTREIMBURSEMENTINTOTALMEDICARE
REIMBURSEMENTDURINGDEMONSTRATIONYEAR1 89
V.1 PSAUYMMMEANRTYAONFDECSOTSITMARTEEIDMDBIUFRFSEERMEENNCTESINBNEUTMWBEEENRSPEORF-EPISODE
EMERGENCYROOMENCOUNTERSANDINPATIENT
ADMISSIONSDURINGMONTHS1THROUGH12,
BYSUBGROUP 99
V.2 SUMMARYOFESTIMATEDDIFFERENCESBETWEENPER-EPISODE
PAYMENTANDCOSTREIMBURSEMENTINTHELIKELIHOOD
OFSKILLEDNURSINGFACILITYANDNONDEMONSTRATION
HOMEHEALTHADMISSIONSDURINGMONTHS1THROUGH12,
BYSUBGROUP 102
V.3 SUMMARYOFESTIMATEDDIFFERENCESBETWEEN PER-EPISODE
PAYMENTANDCOSTREIMBURSEMENTINMEDICAREPARTA
ANDBREIMBURSEMENTDURINGMONTHS1THROUGH12,
BYSUBGROUP 105
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