title: The initial effects of the prospective payment system on nursing home patients.
abstract: We examined the discharge outcomes and admission characteristics of patients admitted to Southern California skilled nursing facilities (SNFs) for the first time following an episode of hospitalization in 1980, 1982-83 (all pre-prospective payment system), and all admissions during July through September 1984 (post-prospective payment). The proportion of patients covered by Medicare on admission was 18 per cent in 1980, 36 per cent in 1982-83, and 57 per cent in 1984. For patients discharged within 30-60 days to SNFs, in all three time periods more Medicare than non-Medicare patients were bed-bound, had indwelling catheters, and were comatose. There were only modest case-mix differences between the groups and no changes over time in discharge outcomes, including the proportion dying in the SNF, or being returned to a hospital. The time-related changes that were found preceded the implementation of the diagnosis related group (DRG) based prospective payment system.
mesh_terms: D000368:Aged; D002140:California; D003953:Diagnosis-Related Groups; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D009735:Nursing Homes / Q000191:economics*; D010351:Patient Discharge; D011445:Prospective Payment System