title: The Balanced Budget Act (1997) and the supplyof nursing home subacute care.
abstract: This article examines the impact of the Medicare prospective payment system (PPS) on the supply of subacute care services by nursing homes. A quasi-experimental interrupted time-series design using Heckman's two-stage regression model is employed to test for changes before and after the implementation of Medicare PPS. Our findings suggest that the change in Medicare reimbursement from cost-based to PPS under the Balanced Budget Act of 1997 resulted in a decrease of 1.7 percent in the supply of subacute care beds by nursing homes. However, this was a one-time, short-term negative effect. The supply of nursing home subacute care remained stable in the long-term. Other environmental factors, such as Medicare hospital discharges, hospital-based subacute care, Medicare managed care penetration, availability of home health, and per capita income were associated with nursing home subacute care supply. Organizational-level factors, such as occupancy rate, RN staff mix, and Medicare payer mix were also predictors of nursing home subacute care supply.
authors.affiliation: Division of Medical Education and Publishing, American College of Physicians, USA.
authors.forename: Amir
authors.initials: A
authors.lastname: Qaseem
authors.forename: Robert
authors.initials: R
authors.lastname: Weech-Maldonado
authors.forename: William
authors.initials: W
authors.lastname: Mkanta
mesh_terms: D002017:Budgets / Q000331:legislation & jurisprudence*; D019538:Health Care Surveys; D006278:Medicare / Q000191:economics; D009735:Nursing Homes / Q000191:economics* / Q000600:supply & distribution; D011445:Prospective Payment System; D012044:Regression Analysis; D019467:Subacute Care / Q000191:economics; D014481:United States