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

Medicare has paid skilled nursing facilities (SNFs) using a prospective payment system (PPS) since 1998. This report offers policy options to refine Medicare’s payment of SNF services by developing alternative patient classification models. Three models classify patients according to expected non-therapy ancillary (NTA) costs: two models use data from the SNF to model NTA costs; a third adds data from prior hospital stays. A fourth model predicts rehabilitation therapy costs using patient characteristics. The fifth uses Diagnostic Related Groups to predict total SNF care costs. The report also simulates options for outlier payments for exceptionally high-cost cases.

This study explores how low-income functionally impaired, elderly persons are able to remain in the community without home- and community-based care (HCBC). We find that, while most rely on informal care and Medicare home care services, many go without needed services. In a comparison with participants, the non-participants were found to be significantly more likely to enter a nursing home. While the study cannot attribute the higher nursing home entry to the absence of HCBC services with certainty, the findings raise the possibility that an expansion of HCBC services could delay the need for nursing home care for this population. (Long, Sharon, Liu, Korbin, Black, Kirsten, O'Keeffe, Janet, and Molony, Sheila. 2005. "Getting by in the Community: Lessons from Frail Elders." Journal of Aging & Social Policy 71(1): 19-44.)

The Medicare home health interim payment system (IPS) implemented in fiscal year 1998 provided very strong incentives for home health agencies (HHAs) to reduce the number of visits provided to each Medicare user and to avoid those beneficiaries whose Medicare plan of care was likely to exceed the average beneficiary cost limit. We analyzed multiple years of data from the Medicare Current Beneficiary Survey (MCBS) to examine how the IPS affected subgroups of the Medicare population by health and socioeconomic characteristics. We found that the IPS strongly reduced overall utilization, but that few subgroups were disproportionately affected. (Health Care Financing Review 25(1): 81–97.)

Though accounting for only a small percentage of total Medicare spending, long-term care hospitals (LTCHs) (defined as having an average length of stay [LOS] of 25 days or more) have been growing, in number and in Medicare expenditures, at a rapid rate in recent years. Because they have not been widely studied, we conducted research to describe the characteristics of this increasingly important Medicare provider type. We found that most LTCHs specialize in the provision of respiratory care or rehabilitation. Information from this study can help inform the development of a Medicare prospective payment system for LTCHs. (Health Care Financing Review 2001 Winter; 23(2):1-18).

Though accounting for only a small percentage of total Medicare spending, long-term care hospitals (LTCHs) (defined as having an average length of stay [LOS] of 25 days or more) have been growing, in number and in Medicare expenditures, at a rapid rate in recent years. Because they have not been widely studied, we conducted research to describe the characteristics of this increasingly important Medicare provider type. We found that most LTCHs specialize in the provision of respiratory care or rehabilitation. Information from this study can help inform the development of a Medicare prospective payment system for LTCHs. . (Health Care Financing Review 2001 Winter; 23(2):1-18).

Home and community-based care (HCBC) has long been viewed as a potentially more cost-effective strategy than nursing home care for providing long-term care services to elderly persons. This study provides information on how low-income, functionally impaired elderly persons who are nursing home eligible are managing their long-term care needs at home without the assistance of Medicaid waiver services. (Home Health Care Services Quarterly 2001; 20(4): 73-90).

This article used the 1992-1996 Medicare Current Beneficiary Survey (MCBS) to examine time trends in rates of disability in activities of daily living and instrumental activities of daily living and in rates of physical limitation among Medicare beneficiaries aged 65 and over. We found that disability is declining and that the trend toward a more educated elderly cohort explains some, but not all, of this decline. In the absence of downward disability trends, per capita Medicare expenditures would have grown even faster than they have. Although the decline in disability prevalence in recent years appears real, whether it continues has enormous implications for the size of the disabled population in the future and for the ability of the society to care for its disabled elderly members. (Journals of Gerontology (B): Psychological Sciences and Social Sciences 2000 September; 55(5): 298-307).

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.

There are two Highlights for each state. The Highlights that focus on health cover Medicaid, other public insurance programs, the health care marketplace, and the role of public providers. The Highlights capture policies in place and planned in 1996 and early 1997.

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