Citation URL: http://www.urban.org/BarbaraGage

The Balanced Budget Act of 1997 dramatically altered Medicare's home health payment provisions. Effectively, the interim payment system froze agency practice patterns at their 1994 casemix levels. While this did not freeze payment levels, it restricted the continuing trend toward long home health episodes. In 1998, concern was raised that these payment limits would restrict access to care for the sickest, most costly populations. This paper analyzes the characteristics of the expensive health care cases to determine whether access to necessary care is being restricted.

This review focuses on (1) characteristics of the population using Medicare's hospice benefit; (2) whether health management organization enrollees are as likely to use hospice as fee-for-service enrollees; (3) how Medicare's eligibility guidelines affect the types of terminally ill patients who enroll in hospice; (4); how nursing facility residents elect hospices and how their choices are affected by institutional residency; (5) the differences in resources used by residents in hospices versus terminally ill residents who are not enrolled; and (6) the differences in care and the outcomes of dying for nursing facility residents who have elected hospice care compared to those who have not.

The goal of this project is to examine the relative quality outcomes of treating four specific clinical conditions across post-acute care providers. The types of care facilities slated for the study are skilled nursing facilities, home health agencies, rehabilitation facilities, and, to a lesser extent, long-term care hospitals. To develop a list of four clinical conditions for study, the list of possibilities was first narrowed to eight. This report describes the analysis leading to the selection of eight candidate conditions.

This paper highlights the important differences between the House and Senate Medicare bills. The differences discussed include fee-for-service changes; private plan changes; changes in beneficiary contributions, increases in the Part B premium, expansion of Specified Low Income Medicare Beneficiary protections, creation of an income-related premium, addition of a home health copayment, and increased age of eligibility. The study concludes with a brief review of other proposed changes that would also affect beneficiaries.

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