The move to a Prospective Payment System (PPS) in home health care will create incentives for providers to minimize care provision. The Interim Payment System (IPS), implemented beginning in late 1997, also created strong pressures to reduce visits per episode. For this analysis, Medicare claims and Outcome and Assessment Information Set (OASIS) data for a national sample of approximately 45,000 home health episodes from the pre-IPS period were categorized into the 80 planned PPS case mix groups described in the proposed rule presented in the October 1999 Federal Register. The visit and outcome patterns pertaining to the pre-IPS period then were compared across the proposed PPS groups, using claims data for visits and OASIS data for outcomes. The visit distribution of each group also was compared to the visits implied for that group under PPS as outlined in the proposed rule. The presentation will review the findings, highlighting those PPS case mix groups for which visit and outcome changes between the pre-IPS and PPS periods are likely to be the most dramatic, and suggesting possible utilization review and quality assurance strategies to consider under PPS.
Learning Objectives: After this presentation, participants will be able to: (1) identify incentives facing providers under a home health prospective payment system (PPS) to reduce services; (2) describe, based on empirical evidence, how such incentives vary among PPS case mix groups; (3) assess which PPS groups may be most likely to exhibit visit and outcome reductions; and (4) explain utilization review and quality assurance strategies appropriate for PPS
Keywords: Home Care, Quality Improvement
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
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.