Medicare Home Health Care: Prospective Payment System Could Reverse RecentDeclines in Spending

摘要

We conducted our analyses using Medicare provider, claims, and beneficiary filesfor calendar years 1994, 1996, and 1999. We chose 1994 as our starting point because its patterns of utilization and spending were used to set the interim payment system (IPS) payment limits. We used 100 percent of Medicare claims from HCFAs home health Standard Analytical Files (SAF), final action claims, for 1994, 1996, and 1999 to analyze patterns and trends in home health utilization. For our analysis of changes in the number of Medicare beneficiaries using home health services, we controlled for changes in Medicare enrollment by using home health users per 1,000 Medicare fee-for-service (FFS) beneficiaries. To examine the response of users, agencies, and areas of high utilization to policy changes, we categorized beneficiaries, HHAs, and states as low-use, medium-use, and high-use according to the average number of visits per user in 1996. Congressional Consideration Given the uncertainties for beneficiaries, HHAs, and the Medicare program associated with the home health agency PPS, we believe that the Congress should consider requiring HCFA to implement a risk-sharing arrangement under the PPS to moderate excessive HHA gains or losses as soon as practicable. We believe that a risk-sharing arrangement would offer protection to Medicare beneficiaries, home health agencies, and the Medicare program from any unintended consequences of the home health PPS.