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Book
Year: 2004 Publisher: Cambridge, Mass. National Bureau of Economic Research
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Digital
Year: 2004 Publisher: Cambridge, Mass. NBER
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Year: 2006 Publisher: Cambridge, Mass. National Bureau of Economic Research
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We use the implementation of a new prospective payment system (PPS) for inpatient rehabilitation facilities (IRFs) to investigate the effect of changes in marginal and average reimbursement on costs. The results show that the IRF PPS led to a significant decline in costs and length of stay. Changes in marginal reimbursement associated with the move from a cost based system to a PPS led to a 7 to 11% reduction in costs. The elasticity of costs with respect average reimbursement ranged from 0.26 to 0.34. Finally, the IRF PPS had little or no impact on costs in other sites of care, mortality, or the rate of return to community residence.
Book
Year: 2004 Publisher: Cambridge, Mass. National Bureau of Economic Research
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To assess the relative impact of clinical factors versus non-clinical factors such as post acute care (PAC) supply - in determining whether patients receive care from skilled nursing facilities (SNFs) or inpatient rehabilitation facilities (IRFs) after discharge from acute care. Medicare acute hospital, IRF and SNF claims provided data on PAC choices; predictors of site of PAC chosen were generated from Medicare claims, provider of services, enrollment file, and Area Resource File data. We used multinomial logit models to predict post-acute care use by elderly patients after hospitalizations for stroke, hip fractures, or lower extremity joint replacements. A file was constructed linking Medicare acute and post-acute utilization data for all sample patients hospitalized in 1999. PAC availability is a more powerful predictor of PAC use than the clinical characteristics in many of our models. The effects of distance to providers and supply of providers are particularly clear in the choice between IRF and SNF care. The farther away the nearest IRF is, and the closer the nearest SNF is, the less likely a patient is to go to an IRF. Similarly, the fewer IRFs, and the more SNFs, there are in the patient's area the less likely the patient is to go to an IRF. In addition, if the hospital from which the patient is discharged has a related IRF or a related SNF the patient is more likely to go there. We find that the availability of PAC is a major determinant of whether patients use such care and which type of PAC facility they use. Further research is needed in order to evaluate whether these findings indicate that a greater supply of PAC leads to both higher use of institutional care and better outcomes or whether it leads to unwarranted expenditures of resources and delays in returning patients to their homes.
Book
ISBN: 1598753649 Year: 2002 Publisher: Santa Monica : RAND Corporation,
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In the Balanced Budget Act of 1997, Congress mandated that Health CareFinancing Administration (HCFA) implement a Prospective Payment System (PPS)for inpatient rehabilitation. The Centers for Medicare and Medicaid Services(CMS, the successor agency to HCFA) issued the final rule governing such aPPS on August 7, 2001.
Hospitals. --- Hospitals --- Inpatients --- Rehabilitation Centers --- Prospective Payment System --- Patients --- Health Facilities --- Reimbursement Mechanisms --- Persons --- Health Care Facilities, Manpower, and Services --- Insurance, Health, Reimbursement --- Health Care --- Financing, Organized --- Names. --- Economics --- Health Care Economics and Organizations --- Prospective payment --- Rehabilitation services --- Inpatients. --- Rehabilitation Centers. --- Prospective Payment System. --- Patients. --- Health Facilities. --- Reimbursement Mechanisms. --- Persons. --- Health Care Facilities Workforce and Services. --- Insurance, Health, Reimbursement. --- Delivery of Health Care. --- Financing, Organized. --- Economics. --- Health Care Economics and Organizations. --- Rehabilitation services.
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