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Hhs Centers For Medicare Medicaid Services - One of the best experts on this subject based on the ideXlab platform.
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medicare program hospital inpatient Prospective Payment systems for acute care hospitals and the long term care hospital Prospective Payment system and policy changes and fiscal year 2019 rates quality reporting requirements for specific providers medicare and medicaid electronic health record ehr incentive programs promoting interoperability programs requirements for eligible hospitals critical access hospitals and eligible professionals medicare cost reporting requirements and physician certif
Federal Register, 2018Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:We are revising the Medicare hospital inpatient Prospective Payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2019. Some of these changes implement certain statutory provisions contained in the 21st Century Cures Act and the Bipartisan Budget Act of 2018, and other legislation. We also are making changes relating to Medicare graduate medical education (GME) affiliation agreements for new urban teaching hospitals. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis, subject to these limits for FY 2019. We are updating the Payment policies and the annual Payment rates for the Medicare Prospective Payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2019. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs (now referred to as the Promoting Interoperability Programs). In addition, we are finalizing modifications to the requirements that apply to States operating Medicaid Promoting Interoperability Programs. We are updating policies for the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to the required supporting documentation for an acceptable Medicare cost report submission and the supporting information for physician certification and recertification of claims.
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medicare program Prospective Payment system and consolidated billing for skilled nursing facilities snf final rule for fy 2019 snf value based purchasing program and snf quality reporting program final rule
Federal Register, 2018Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:This final rule updates the Payment rates used under the Prospective Payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2019. This final rule also replaces the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG–IV) model, with a revised case-mix methodology called the Patient- Driven Payment Model (PDPM) beginning on October 1, 2019. The rule finalizes revisions to the regulation text that describes a beneficiary's SNF "resident" status under the consolidated billing provision and the required content of the SNF level of care certification. The rule also finalizes updates to the SNF Quality Reporting Program (QRP) and the Skilled Nursing Facility Value-Based Purchasing (VBP) Program.
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medicare program hospital outpatient Prospective Payment and ambulatory surgical center Payment systems and quality reporting programs final rule with comment period
Federal Register, 2017Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:This final rule with comment period revises the Medicare hospital outpatient Prospective Payment system (OPPS) and the Medicare ambulatory surgical center (ASC) Payment system for CY 2018 to implement changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the Payment rates for Medicare services paid under the OPPS and those paid under the ASC Payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program.
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medicare program changes to hospital outpatient Prospective Payment and ambulatory surgical center Payment systems and quality reporting programs final rule with comment period
Federal Register, 2017Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:This final rule with comment period revises the Medicare hospital outpatient Prospective Payment system (OPPS) and the Medicare ambulatory surgical center (ASC) Payment system for CY 2018 to implement changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the Payment rates for Medicare services paid under the OPPS and those paid under the ASC Payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program.
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medicare program Prospective Payment system and consolidated billing for skilled nursing facilities for fy 2017 snf value based purchasing program snf quality reporting program and snf Payment models research final rule
Federal Register, 2016Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:This final rule updates the Payment rates used under the Prospective Payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2017. In addition, it specifies a potentially preventable readmission measure for the Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP), and implements requirements for that program, including performance standards, a scoring methodology, and a review and correction process for performance information to be made public, aimed at implementing value-based purchasing for SNFs. Additionally, this final rule includes additional polices and measures in the Skilled Nursing Facility Quality Reporting Program (SNF QRP). This final rule also responds to comments on the SNF Payment Models Research (PMR) project.
Jose J Escarce - One of the best experts on this subject based on the ideXlab platform.
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effects of medicare Payment reform evidence from the home health interim and Prospective Payment systems
Journal of Health Economics, 2014Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P NewhouseAbstract:Medicare continues to implement Payment reforms that shift reimbursement from fee-for-service toward episode-based Payment, affecting average and marginal Payment. We contrast the effects of two reforms for home health agencies. The home health interim Payment system in 1997 lowered both types of Payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The home health Prospective Payment system in 2000 raised average but lowered marginal Payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality.
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the effect of Prospective Payment on admission and treatment policy evidence from inpatient rehabilitation facilities
Journal of Health Economics, 2013Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P NewhouseAbstract:We examine provider responses to the Medicare inpatient rehabilitation facility (IRF) Prospective Payment system (PPS), which simultaneously reduced marginal reimbursement and increased average reimbursement. IRFs could respond to the PPS by changing the number of patients admitted, admitting different types of patients, or changing the intensity of care. We use Medicare claims data to separately estimate each type of provider response. We also examine changes in patient outcomes and spillover effects on other post-acute care providers. We find that costs of care initially fell following the PPS, which we attribute to changes in treatment decisions rather than the characteristics of patients admitted to IRFs within the diagnostic categories we examine. However, the probability of admission to IRFs increased after the PPS due to the expanded admission policies of providers. We find modest spillover effects in other post-acute settings and negative health impacts for only one of three diagnostic groups studied.
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effects of medicare Payment reform evidence from the home health interim and Prospective Payment systems
2012Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P NewhouseAbstract:Medicare continues to implement Payment reforms that shift reimbursement from fee-for-service towards episode-based Payment, affecting average and marginal reimbursement. We contrast the effects of two reforms for home health agencies. The Home Health Interim Payment System in 1997 lowered both types of reimbursement; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The Home Health Prospective Payment System in 2000 raised average but lowered marginal reimbursement with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality.
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the effect of Prospective Payment on admission and treatment policy evidence from inpatient rehabilitation facilities
Social Science Research Network, 2011Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P NewhouseAbstract:We examine provider responses to the Medicare inpatient rehabilitation facility (IRF) Prospective Payment system (PPS), which simultaneously reduced marginal reimbursement and increased average reimbursement. IRFs could respond to the PPS by changing the total number of patients admitted, admitting different types of patients, or changing the intensity of care for admitted patients. We use Medicare claims data to separately estimate each type of provider response to the PPS. We also examine changes in patient outcomes and spillover effects on other post acute care providers. We find that costs of care initially fell following the PPS implementation, which we attribute to changes in treatment decisions rather than the types of patients admitted to IRFs. However, the probability of admission to IRFs increased after the PPS due to the expanded admission policies of providers. We find modest spillover effects on skilled nursing home costs and no substantive impact on patient health outcomes.
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effects of competition on the cost and quality of inpatient rehabilitation care under Prospective Payment
Health Services Research, 2010Co-Authors: Carrie H Colla, Melinda Beeuwkes Buntin, Jose J Escarce, Neeraj SoodAbstract:Every year millions of Medicare beneficiaries are discharged from acute care hospitals into institutional postacute care (PAC) in inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and long-term care hospitals (LTCHs). Each of these institutional settings offers a different level of care. IRFs provide the most intensive care rehabilitation care (3 or more hours a day of rehabilitation therapy). SNFs can also provide inpatient rehabilitation under the Medicare benefit, although it is generally less intensive than that provided in IRFs (Gage 1999). From 1988 to 1997, Medicare expenditures for PAC grew at an average annual rate of 25 percent, making it the fastest-growing category of Medicare spending [Medicare Payment Advisory Commission (MedPAC) 2003]. Congress responded by mandating Prospective Payment for PAC providers. Between 1998 and 2002, Medicare introduced Prospective Payment systems (PPSs) for SNFs (1998), HHAs (2000), IRFs (2002), and LTCHs (2002). The IRF PPS uses per discharge Payments to provide incentives for limiting costs per rehabilitation stay. Payment amounts are based on patient categories defined by the patient's rehabilitation impairment (e.g., stroke, hip fracture), functional status, and comorbidities (Carter et al. 2002). The new Payment systems blunted the rate of growth in Medicare expenditures for PAC, although these expenditures continued to rise steadily and now account for about 11 percent of total Medicare spending (Buntin, Colla, and Escarce 2009; MedPAC 2009;). Researchers have examined the effect of the new Payment systems in PAC on resource use and quality and outcomes of care. Early studies found small decreases in SNF utilization, accompanied by increases in the use of other PAC providers, after implementation of the PPS for SNFs (Angelelli et al. 2002; McCall et al. 2003; MedPAC 2003; Buntin et al. 2009;). Rates of adverse outcomes, including acute care readmissions and mortality, did not change (Angelelli et al. 2002; McCall et al. 2003;). By contrast, a later analysis found worsening of certain SNF outcomes between 2000 and 2004, and other studies have found declines in staffing and the intensity of services (Yip, Wilber, and Myrtle 2002; White 2003, 2005; Wodchis, Fries, and Hirth 2004; Murray et al. 2005; MedPAC 2006). Most recently, a study of 120 IRFs found that these facilities reduced costs per discharge during the first year of the IRF PPS (McCue and Thompson 2006). In a national study, Sood, Buntin, and Escarce (2008) found that implementation of the IRF PPS led to sizable declines in costs and length of stay, especially among facilities that had higher Payment limits under the preexisting Payment system, but patients' rates of return to the community and mortality were unaffected. The Payment system is not the only economic factor that affects resource use and quality of care among health care providers. An extensive body of research on acute care hospitals has shown that market structure, especially the degree of competition, matters as well. Studies of acute care hospitals, moreover, have found that the effects of competition on costs and quality depend on the way providers are paid and how prices for their services are set (e.g., Robinson and Luft 1985; Zwanziger and Melnick 1988; Keeler, Melnick, and Zwanziger 1999; Kessler and McClellan 2000; Mukamel, Zwanziger, and Tomaszewski 2001; Bundorf et al. 2004; Escarce, Jain, and Rogowski 2006; Rogowski, Jain, and Escarce 2007;). For instance, competition increased costs under cost-based reimbursement, whereas it decreased costs under selective contracting based on prices. Much less is known about the effects of competition in PAC markets. Further, the available research has focused on long-term care services provided in nursing homes, rather than on PAC. Studies conducted in the 1990s found that higher competition among nursing homes was associated with better structural and process quality and with adoption of total quality management (Zinn 1994; Zinn, Weech, and Brannon 1998;). Similarly, recent studies indicate that higher competition is associated with higher scores on the quality measures reported on the Centers for Medicare and Medicaid Services Nursing Home Compare Website (Zinn et al. 1998; Starkey, Weech-Maldonado, and Mor 2005; Castle, Engberg, and Liu 2007; Castle, Liu, and Engberg 2008; Centers for Medicare and Medicaid Services 2009;). To our knowledge, no study has assessed the impact of competition on the cost and quality of PAC under the recently implemented PPSs. To begin to address this gap in the literature, the current study examines the effect of competition in institutional PAC markets on resource use and health outcomes for patients who received PAC in IRFs, the most intensive setting for postacute rehabilitation care, during the first 18 months after Prospective Payment went into effect. The study focuses on patients discharged from an acute care hospital after a stroke or hip fracture, two of the conditions that most often receive institutional PAC. The empirical analyses incorporate two noteworthy innovations. First, we construct a measure of the competition facing each IRF that accounts for the fact that SNFs may be viable substitutes for IRFs in many clinical situations. Second, we use instrumental variables estimation to account for the likely endogeneity of competition.
Neeraj Sood - One of the best experts on this subject based on the ideXlab platform.
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effects of medicare Payment reform evidence from the home health interim and Prospective Payment systems
Journal of Health Economics, 2014Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P NewhouseAbstract:Medicare continues to implement Payment reforms that shift reimbursement from fee-for-service toward episode-based Payment, affecting average and marginal Payment. We contrast the effects of two reforms for home health agencies. The home health interim Payment system in 1997 lowered both types of Payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The home health Prospective Payment system in 2000 raised average but lowered marginal Payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality.
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the effect of Prospective Payment on admission and treatment policy evidence from inpatient rehabilitation facilities
Journal of Health Economics, 2013Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P NewhouseAbstract:We examine provider responses to the Medicare inpatient rehabilitation facility (IRF) Prospective Payment system (PPS), which simultaneously reduced marginal reimbursement and increased average reimbursement. IRFs could respond to the PPS by changing the number of patients admitted, admitting different types of patients, or changing the intensity of care. We use Medicare claims data to separately estimate each type of provider response. We also examine changes in patient outcomes and spillover effects on other post-acute care providers. We find that costs of care initially fell following the PPS, which we attribute to changes in treatment decisions rather than the characteristics of patients admitted to IRFs within the diagnostic categories we examine. However, the probability of admission to IRFs increased after the PPS due to the expanded admission policies of providers. We find modest spillover effects in other post-acute settings and negative health impacts for only one of three diagnostic groups studied.
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effects of medicare Payment reform evidence from the home health interim and Prospective Payment systems
2012Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P NewhouseAbstract:Medicare continues to implement Payment reforms that shift reimbursement from fee-for-service towards episode-based Payment, affecting average and marginal reimbursement. We contrast the effects of two reforms for home health agencies. The Home Health Interim Payment System in 1997 lowered both types of reimbursement; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The Home Health Prospective Payment System in 2000 raised average but lowered marginal reimbursement with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality.
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the effect of Prospective Payment on admission and treatment policy evidence from inpatient rehabilitation facilities
Social Science Research Network, 2011Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P NewhouseAbstract:We examine provider responses to the Medicare inpatient rehabilitation facility (IRF) Prospective Payment system (PPS), which simultaneously reduced marginal reimbursement and increased average reimbursement. IRFs could respond to the PPS by changing the total number of patients admitted, admitting different types of patients, or changing the intensity of care for admitted patients. We use Medicare claims data to separately estimate each type of provider response to the PPS. We also examine changes in patient outcomes and spillover effects on other post acute care providers. We find that costs of care initially fell following the PPS implementation, which we attribute to changes in treatment decisions rather than the types of patients admitted to IRFs. However, the probability of admission to IRFs increased after the PPS due to the expanded admission policies of providers. We find modest spillover effects on skilled nursing home costs and no substantive impact on patient health outcomes.
-
effects of competition on the cost and quality of inpatient rehabilitation care under Prospective Payment
Health Services Research, 2010Co-Authors: Carrie H Colla, Melinda Beeuwkes Buntin, Jose J Escarce, Neeraj SoodAbstract:Every year millions of Medicare beneficiaries are discharged from acute care hospitals into institutional postacute care (PAC) in inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and long-term care hospitals (LTCHs). Each of these institutional settings offers a different level of care. IRFs provide the most intensive care rehabilitation care (3 or more hours a day of rehabilitation therapy). SNFs can also provide inpatient rehabilitation under the Medicare benefit, although it is generally less intensive than that provided in IRFs (Gage 1999). From 1988 to 1997, Medicare expenditures for PAC grew at an average annual rate of 25 percent, making it the fastest-growing category of Medicare spending [Medicare Payment Advisory Commission (MedPAC) 2003]. Congress responded by mandating Prospective Payment for PAC providers. Between 1998 and 2002, Medicare introduced Prospective Payment systems (PPSs) for SNFs (1998), HHAs (2000), IRFs (2002), and LTCHs (2002). The IRF PPS uses per discharge Payments to provide incentives for limiting costs per rehabilitation stay. Payment amounts are based on patient categories defined by the patient's rehabilitation impairment (e.g., stroke, hip fracture), functional status, and comorbidities (Carter et al. 2002). The new Payment systems blunted the rate of growth in Medicare expenditures for PAC, although these expenditures continued to rise steadily and now account for about 11 percent of total Medicare spending (Buntin, Colla, and Escarce 2009; MedPAC 2009;). Researchers have examined the effect of the new Payment systems in PAC on resource use and quality and outcomes of care. Early studies found small decreases in SNF utilization, accompanied by increases in the use of other PAC providers, after implementation of the PPS for SNFs (Angelelli et al. 2002; McCall et al. 2003; MedPAC 2003; Buntin et al. 2009;). Rates of adverse outcomes, including acute care readmissions and mortality, did not change (Angelelli et al. 2002; McCall et al. 2003;). By contrast, a later analysis found worsening of certain SNF outcomes between 2000 and 2004, and other studies have found declines in staffing and the intensity of services (Yip, Wilber, and Myrtle 2002; White 2003, 2005; Wodchis, Fries, and Hirth 2004; Murray et al. 2005; MedPAC 2006). Most recently, a study of 120 IRFs found that these facilities reduced costs per discharge during the first year of the IRF PPS (McCue and Thompson 2006). In a national study, Sood, Buntin, and Escarce (2008) found that implementation of the IRF PPS led to sizable declines in costs and length of stay, especially among facilities that had higher Payment limits under the preexisting Payment system, but patients' rates of return to the community and mortality were unaffected. The Payment system is not the only economic factor that affects resource use and quality of care among health care providers. An extensive body of research on acute care hospitals has shown that market structure, especially the degree of competition, matters as well. Studies of acute care hospitals, moreover, have found that the effects of competition on costs and quality depend on the way providers are paid and how prices for their services are set (e.g., Robinson and Luft 1985; Zwanziger and Melnick 1988; Keeler, Melnick, and Zwanziger 1999; Kessler and McClellan 2000; Mukamel, Zwanziger, and Tomaszewski 2001; Bundorf et al. 2004; Escarce, Jain, and Rogowski 2006; Rogowski, Jain, and Escarce 2007;). For instance, competition increased costs under cost-based reimbursement, whereas it decreased costs under selective contracting based on prices. Much less is known about the effects of competition in PAC markets. Further, the available research has focused on long-term care services provided in nursing homes, rather than on PAC. Studies conducted in the 1990s found that higher competition among nursing homes was associated with better structural and process quality and with adoption of total quality management (Zinn 1994; Zinn, Weech, and Brannon 1998;). Similarly, recent studies indicate that higher competition is associated with higher scores on the quality measures reported on the Centers for Medicare and Medicaid Services Nursing Home Compare Website (Zinn et al. 1998; Starkey, Weech-Maldonado, and Mor 2005; Castle, Engberg, and Liu 2007; Castle, Liu, and Engberg 2008; Centers for Medicare and Medicaid Services 2009;). To our knowledge, no study has assessed the impact of competition on the cost and quality of PAC under the recently implemented PPSs. To begin to address this gap in the literature, the current study examines the effect of competition in institutional PAC markets on resource use and health outcomes for patients who received PAC in IRFs, the most intensive setting for postacute rehabilitation care, during the first 18 months after Prospective Payment went into effect. The study focuses on patients discharged from an acute care hospital after a stroke or hip fracture, two of the conditions that most often receive institutional PAC. The empirical analyses incorporate two noteworthy innovations. First, we construct a measure of the competition facing each IRF that accounts for the fact that SNFs may be viable substitutes for IRFs in many clinical situations. Second, we use instrumental variables estimation to account for the likely endogeneity of competition.
Joseph P Newhouse - One of the best experts on this subject based on the ideXlab platform.
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effects of medicare Payment reform evidence from the home health interim and Prospective Payment systems
Journal of Health Economics, 2014Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P NewhouseAbstract:Medicare continues to implement Payment reforms that shift reimbursement from fee-for-service toward episode-based Payment, affecting average and marginal Payment. We contrast the effects of two reforms for home health agencies. The home health interim Payment system in 1997 lowered both types of Payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The home health Prospective Payment system in 2000 raised average but lowered marginal Payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality.
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the effect of Prospective Payment on admission and treatment policy evidence from inpatient rehabilitation facilities
Journal of Health Economics, 2013Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P NewhouseAbstract:We examine provider responses to the Medicare inpatient rehabilitation facility (IRF) Prospective Payment system (PPS), which simultaneously reduced marginal reimbursement and increased average reimbursement. IRFs could respond to the PPS by changing the number of patients admitted, admitting different types of patients, or changing the intensity of care. We use Medicare claims data to separately estimate each type of provider response. We also examine changes in patient outcomes and spillover effects on other post-acute care providers. We find that costs of care initially fell following the PPS, which we attribute to changes in treatment decisions rather than the characteristics of patients admitted to IRFs within the diagnostic categories we examine. However, the probability of admission to IRFs increased after the PPS due to the expanded admission policies of providers. We find modest spillover effects in other post-acute settings and negative health impacts for only one of three diagnostic groups studied.
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effects of medicare Payment reform evidence from the home health interim and Prospective Payment systems
2012Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P NewhouseAbstract:Medicare continues to implement Payment reforms that shift reimbursement from fee-for-service towards episode-based Payment, affecting average and marginal reimbursement. We contrast the effects of two reforms for home health agencies. The Home Health Interim Payment System in 1997 lowered both types of reimbursement; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The Home Health Prospective Payment System in 2000 raised average but lowered marginal reimbursement with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality.
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the effect of Prospective Payment on admission and treatment policy evidence from inpatient rehabilitation facilities
Social Science Research Network, 2011Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P NewhouseAbstract:We examine provider responses to the Medicare inpatient rehabilitation facility (IRF) Prospective Payment system (PPS), which simultaneously reduced marginal reimbursement and increased average reimbursement. IRFs could respond to the PPS by changing the total number of patients admitted, admitting different types of patients, or changing the intensity of care for admitted patients. We use Medicare claims data to separately estimate each type of provider response to the PPS. We also examine changes in patient outcomes and spillover effects on other post acute care providers. We find that costs of care initially fell following the PPS implementation, which we attribute to changes in treatment decisions rather than the types of patients admitted to IRFs. However, the probability of admission to IRFs increased after the PPS due to the expanded admission policies of providers. We find modest spillover effects on skilled nursing home costs and no substantive impact on patient health outcomes.
David C Grabowski - One of the best experts on this subject based on the ideXlab platform.
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effects of medicare Payment reform evidence from the home health interim and Prospective Payment systems
Journal of Health Economics, 2014Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P NewhouseAbstract:Medicare continues to implement Payment reforms that shift reimbursement from fee-for-service toward episode-based Payment, affecting average and marginal Payment. We contrast the effects of two reforms for home health agencies. The home health interim Payment system in 1997 lowered both types of Payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The home health Prospective Payment system in 2000 raised average but lowered marginal Payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality.
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the effect of Prospective Payment on admission and treatment policy evidence from inpatient rehabilitation facilities
Journal of Health Economics, 2013Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P NewhouseAbstract:We examine provider responses to the Medicare inpatient rehabilitation facility (IRF) Prospective Payment system (PPS), which simultaneously reduced marginal reimbursement and increased average reimbursement. IRFs could respond to the PPS by changing the number of patients admitted, admitting different types of patients, or changing the intensity of care. We use Medicare claims data to separately estimate each type of provider response. We also examine changes in patient outcomes and spillover effects on other post-acute care providers. We find that costs of care initially fell following the PPS, which we attribute to changes in treatment decisions rather than the characteristics of patients admitted to IRFs within the diagnostic categories we examine. However, the probability of admission to IRFs increased after the PPS due to the expanded admission policies of providers. We find modest spillover effects in other post-acute settings and negative health impacts for only one of three diagnostic groups studied.
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effects of medicare Payment reform evidence from the home health interim and Prospective Payment systems
2012Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P NewhouseAbstract:Medicare continues to implement Payment reforms that shift reimbursement from fee-for-service towards episode-based Payment, affecting average and marginal reimbursement. We contrast the effects of two reforms for home health agencies. The Home Health Interim Payment System in 1997 lowered both types of reimbursement; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The Home Health Prospective Payment System in 2000 raised average but lowered marginal reimbursement with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality.
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Medicare Prospective Payment and the volume and intensity of skilled nursing facility services.
Journal of health economics, 2011Co-Authors: David C Grabowski, Christopher C. Afendulis, Thomas G McguireAbstract:In 1998, Medicare adopted a per diem Prospective Payment System (PPS) for skilled nursing facility care, which was intended to deter the use of high-cost rehabilitative services. The average per diem decreased under the PPS, but because per diems increased for greater therapy minutes, the ability of the PPS to deter the use of high-intensity services was questionable. In this study, we assess how the PPS affected the volume and intensity of Medicare services. By volume we mean the product of the number of Medicare residents in a facility and the average length-of-stay, by intensity we mean the time per week devoted to rehabilitation therapy. Our results indicate that the number of Medicare residents decreased under PPS, but rehabilitative services and therapy minutes increased while length-of-stay remained relatively constant. Not surprisingly, when subsequent Medicare policy changes increased Payment rates, Medicare volume far surpassed the levels seen in the pre-PPS period.
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the effect of Prospective Payment on admission and treatment policy evidence from inpatient rehabilitation facilities
Social Science Research Network, 2011Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P NewhouseAbstract:We examine provider responses to the Medicare inpatient rehabilitation facility (IRF) Prospective Payment system (PPS), which simultaneously reduced marginal reimbursement and increased average reimbursement. IRFs could respond to the PPS by changing the total number of patients admitted, admitting different types of patients, or changing the intensity of care for admitted patients. We use Medicare claims data to separately estimate each type of provider response to the PPS. We also examine changes in patient outcomes and spillover effects on other post acute care providers. We find that costs of care initially fell following the PPS implementation, which we attribute to changes in treatment decisions rather than the types of patients admitted to IRFs. However, the probability of admission to IRFs increased after the PPS due to the expanded admission policies of providers. We find modest spillover effects on skilled nursing home costs and no substantive impact on patient health outcomes.
