title: Access to postacute nursing home care before and after the BBA. Balanced Budget Act.
abstract: Anecdotal reports in the wake of the Balanced Budget Act (BBA) of 1997 raised concerns about restricted access to postacute nursing facility care for Medicare beneficiaries requiring costly, medically complex services. Using all Medicare Part A hospital and nursing facility claims for providers in the state of Ohio and a refined method of identifying hospitalized beneficiaries who were the most at risk, we observed only a small decrease in the proportion of the costliest patients discharged to nursing facilities in 1999 compared with pre-BBA years. Average hospital length-of-stay increased only slightly in 1999, and there were no changes in rehospitalization rates for the costliest patient types. However, reduced rates of admission were concentrated in specific types of nursing facilities, suggesting a need to closely monitor the effects of ongoing post-BBA policy updates.
authors.affiliation: Center for Gerontology and Health Care Research, Brown University, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Angelelli
authors.forename: David
authors.initials: D
authors.lastname: Gifford
authors.forename: Orna
authors.initials: O
authors.lastname: Intrator
authors.forename: Pedro
authors.initials: P
authors.lastname: Gozalo
authors.forename: Linda
authors.initials: L
authors.lastname: Laliberte
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000368:Aged; D006291:Health Policy / Q000331:legislation & jurisprudence; D006297:Health Services Accessibility / Q000191:economics / Q000639:trends*; D006302:Health Services Research; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016344:Medicare Part A / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D009820:Ohio; D010359:Patient Readmission / Q000706:statistics & numerical data; D011445:Prospective Payment System / Q000331:legislation & jurisprudence*; D012866:Skilled Nursing Facilities / Q000145:classification / Q000191:economics / Q000706:statistics & numerical data*; D019467:Subacute Care / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States