Medicare Prospective Payment and Posthospital Transfers to Subacute Care

Dados Bibliográficos

ID9102923
AutoresMichael A Morrisey (0000-0001-9357-1141, University of Alabama at Birmingham, autor correspondente), Frank A Sloan (0000-0002-9902-1009, Vanderbilt University), Joseph Valvona (Vanderbilt University Medical Center)
Ano1988
Volume26
Fascículo7
Páginas685-698
Data de publicação1988-07-01
Peer ReviewedSim
Open AccessNão
TipoARTICLE
PeriódicoMedical Care (JOURNAL)
Identificadores do periódicoISSN: 0025-7079 • E-ISSN: 1537-1948
EditoraOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/00005650-198807000-00004
PMID3134581
OpenAlexW2074998002
IdiomaEN
Citações recebidas10
Referências citadas3

This study analyzed the early effects of the Medicare Prospective Payment System (PPS) on the likelihood of hospital's discharging Medicare beneficiaries to skilled nursing facilities (SNFs), intermediate care facilities (ICFs), and home health agencies. It also examined length of stay before transfer. Discharge abstract data on patients in five DRG groups were studied. Data were obtained from 501 hospitals for the third quarters of 1980, 1983, 1984, and 1985. Multinomial logit and ordinary least squares regression techniques were employed. After controlling for hospital and patient characteristics, including severity of illness, it was found that the probability of transfer increased substantially in virtually all DRGs and discharge destinations studied. This was particularly true for patients with stroke, pneumonia, and major joint and hip procedure. The analysis reveals that PPS increased the rate of discharges to subacute facilities. This effect was stronger for transfer to SNFs than to ICFs and home health agencies. Further, the impact of PPS on transfers was greater in 1985 than in 1984. Lengths of stay before transfer tended to decline in almost all DRGs and destinations examined. However, the effects of PPS on lengths of stay of transferred patients were not statistically significant at conventional levels. The results suggest that payment experiments with broader forms of bundled services are in order, as are experiments with hospital acute-subacute swing beds

Business · Case mix index · Health care · Health insurance · Logistic regression · Multinomial logistic regression · Payment · Prospective cohort study · Prospective payment system · Statistics · Emergency Medicine · Finance · Geriatric Care and Nursing Homes · Global Health Care Issues · Healthcare Policy and Management · Internal Medicine · Medicine · Nursing