title: Medicare payment reform and provider entry and exit in the post-acute care market.
abstract: OBJECTIVE
  To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers.
  
  
  METHODS
  Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010.
  
  
  METHODS
  We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities.
  
  
  METHODS
  We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010. We linked these measures with demographic information from the Census and American Community Survey, information on Certificate of Need laws, and Medicare share of facilities in each market drawn from Cost Report data.
  
  
  RESULTS
  Payment reforms reducing average and marginal payments reduced entries and increased exits from the market. Entry effects were larger and more persistent than exit effects. Entry and exit rates fluctuated more for home health agencies than skilled nursing facilities. Effects on number of providers were consistent with entry and exit effects.
  
  
  CONCLUSIONS
  Payment reform affects market entry and exit, which in turn may affect market structure, access to care, quality and cost of care, and patient outcomes. Policy makers should consider potential impacts of payment reforms on post-acute care market structure when implementing these reforms.
authors.affiliation: RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Huckfeldt
authors.forename: Neeraj
authors.initials: N
authors.lastname: Sood
authors.forename: John A
authors.initials: JA
authors.lastname: Romley
authors.forename: Alessandro
authors.initials: A
authors.lastname: Malchiodi
authors.forename: José J
authors.initials: JJ
authors.lastname: Escarce
mesh_terms: D018166:Health Care Reform / Q000191:economics* / Q000331:legislation & jurisprudence*; D006291:Health Policy; D018574:Home Care Agencies / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D006278:Medicare / Q000191:economics* / Q000331:legislation & jurisprudence*; D020406:Medicare Payment Advisory Commission; D058991:Patient Protection and Affordable Care Act; D011445:Prospective Payment System / Q000191:economics* / Q000331:legislation & jurisprudence*; D012047:Rehabilitation Centers / Q000191:economics / Q000331:legislation & jurisprudence; D012051:Reimbursement Mechanisms / Q000191:economics / Q000331:legislation & jurisprudence; D012866:Skilled Nursing Facilities / Q000191:economics / Q000331:legislation & jurisprudence; D019467:Subacute Care / Q000191:economics; D014481:United States
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