Impact of the Medicare Catastrophic Act on the Long-Term Care System. ExecutiveSummary

摘要

Summarizes the imapcts of the MCCA on beneficiary use of nursing homes andhospices, using two data sources: (1) detailed patient based data from a for-profit nursing home chain and (2) claims data for a 1 percent sample of Medicare beneficiaries. Findings suggest that the nursing home industry and Medicare beneficiaries benefited from the MCCA changes to the SNF and hospice benefits. Analyses found significant increase in the proportion of nursing home residents whose payer source was Medicare during 1989; found that more residents were admitted to nursing homes directly from home in that year, especially among those reimbursed by Medicare; and found a shift in the case mix severity of individuals entering and care for in nursing homes, as evidenced by the significant increase in clinically complex patients admitted to nursing homes in 1989 and the increase in deaths within the nursing home. The findings that residents were more likely to die within the nursing home than to be discharged to a hospital to die during the MCCA period is consistent with the finding of an increasing trend toward the diversification of nursing home services, including the development of special care units for the terminally ill. A large increase in the proportion of nursing home episodes involved shifting of payer source from either Medicaid or private pay to Medicare.