This paper investigates the impact of managed care on costs and outcomes for mechanically ventilated seriously ill patients discharged under DRG 475 and DRG 483 under regulated and competitive hospital reimbursement systems in New York State. Study goals are to determine whether improved survival rates among managed care patients are due to self-selection or the elimination of ineffective care in the inpatient setting, and to identify cost-shifting between venues of care. Medical record, billing, and National Death Index data from a high-volume medical center are used to track the chronology of costs and outcomes for 400 patients under managed care and traditional coverage before and after the institution of competitive reimbursements during 1995-1998. These data provide information that is unavailable from public-use administrative data. Ordinary Least Square and identity-linked geometric regression models are used to test hypotheses concerning the impacts of managed care and reimbursement structures on survival rates, lengths of stay in the ICU and hospital, discharge patterns, and costs per survivor. Preliminary findings show that active discharge planning, and better interactions between providers and patients can lead to more cost-effective outcomes and reduction in futile care. These findings inform public and private policy concerning the impact of managed care, reimbursement regimes, and hospital practice patterns on cost-effective outcomes across acute and post-acute settings for critically ill patients.
Learning Objectives: The participant will be able to evaluate the impacts of health care financing and delivery system changes on the coordination of care and health outcomes of the critically ill elderly
Keywords: Health Care Managed Care, Health Care Utilization
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: ---
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.