BBA Effects on Geographic Variation in Post-Acute Care Final rept. (Sept, 1, 2003-Aug. 31, 2004)

摘要

The purpose of the report is to examine how geographic regions responded to the initial Medicare post-acute care (PAC) payment reforms enacted by the Balanced Budget Act (BBA) of 1997. As PAC use has varied across geographic regions over time, regions could have responded to the reforms differently. Varied regional responses to the reforms are of particular concern in a health care sector with no clear clinical guidelines and no consensus on optimal outcomes. Claims data for the 5% Medicare beneficiary sample for calendar years 1996 and 2000 were used. Elderly beneficiaries discharged alive from hospitals for 6 disease groups with high frequency of PAC use were included. Multinomial logistic regression was used to examine changes in PAC use before and after the BBA of 1997. Changes in early hospital readmission were examined by the Breslow-Day statistics for the homogeneous association across regions. Regions responded differently to the BBA changes. The consequential redistribution of services among PAC settings also varied across regions. However, changes in early hospital readmission were similar across regions. Our findings raise the question of whether patients are discharged to appropriate settings for PAC services. Optimal outcomes across PAC settings should be better understood to guide the use of such highly substitutable and supply-sensitive services. Comparable outcomes assessment information across settings is critical if we are to monitor adverse outcomes resulting from inappropriate discharge and also address the issue of accountability.