title: Impact of changes in Medicare Home Health care reimbursement on month-to-month Home Health utilization between 1996 and 2001 for a national sample of patients undergoing orthopedic procedures.
abstract: BACKGROUND
  Beginning October 1, 1997, Medicare implemented a series of major changes to the Home Health (HH) reimbursement system. Reimbursements were first significantly reduced under the Interim Payment System (IPS) and then relaxed slightly until implementation of the HH Prospective Payment System (PPS) on October 1, 2000.
  
  
  OBJECTIVE
  The objective of this study was to examine the impact of reimbursement policy on HH care utilization.
  
  
  METHODS
  We postulated that in response to the initial changes, there would be reductions in both the probability of any HH use and the number of HH visits per HH user. Under PPS, we postulated there would be further reduction in number of HH visits. We tested whether the policy response differed by HH agency structure and whether subgroups of patients were differentially affected. An interrupted time-series analysis was conducted to examine month-to-month probability of HH selection and the number of HH visits among users.
  
  
  METHODS
  A 100% sample of all Medicare recipients undergoing either elective joint replacement (1.6 million hospital discharges) or surgical management of hip fracture (1.2 million hospital discharges) between January 1996 and December 2001 was selected.
  
  
  RESULTS
  Under the IPS, the probability of any HH use and number of visits per episode of HH care fell until the IPS was refined in October 1998. With implementation of the PPS, HH visits fell commensurately. Differentially larger reductions in care were noted at for-profit HH agencies, for the elderly, women, patients receiving state assistance, and patients first discharged to skilled nursing facility or rehabilitation hospitals.
  
  
  CONCLUSIONS
  Changes in month-to-month utilization of HH services were sharp and well correlated with policy implementation dates, strengthening the evidence for a causal association between policy and patient care in the midst of a sea of concurrent policy changes. Greater reductions in HH visits were noted for vulnerable groups.
authors.affiliation: Department of Medicine, David Geffen School of Medicine, Los Angeles, California 90095-1670, USA. jfitzgerald@mednet.ucla.edu
authors.forename: John D
authors.initials: JD
authors.lastname: FitzGerald
authors.forename: Carol M
authors.initials: CM
authors.lastname: Mangione
authors.forename: John
authors.initials: J
authors.lastname: Boscardin
authors.forename: Gerald
authors.initials: G
authors.lastname: Kominski
authors.forename: Bevra
authors.initials: B
authors.lastname: Hahn
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008297:Male; D006278:Medicare / Q000458:organization & administration*; D008875:Middle Aged