 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Amir Qaseem, MD, MHA, Department of Health Policy & Administration, The Pennsylvania State University, 1846 Park Forest Avenue, State College, PA 16803, (814) 861-6397, aqaseem@psu.edu and Robert Weech-Maldonado, PhD, MBA, Department of Health Policy & Administration, Pennsylvania State University, 116 Henderson Building, University Park, PA 16801.
This study examines the impact of Medicare Prospective Payment System (PPS) on the level of subacute care services provided in nursing homes. Data sources include the Online Survey Certification of Automated Records (OSCAR), the Area Resource File, the Medicare managed care market penetration data files, and the Medicaid reimbursement surveys. The study analyses all Medicare and Medicaid certified nursing homes from 1993 to 2000. A quasi-experimental interrupted time-series design using Heckman’s two-stage regression model is employed to test for changes in the percentage of subacute care beds before and after the implementation of Medicare PPS in 1997. Organizational and market factors that may influence the provision of subacute care by nursing homes are also examined. Our analysis shows that the percentage of subacute care beds in nursing homes decreased significantly after the implementation of Medicare PPS. However, the trend in nursing homes’ subacute care beds did not change significantly after the implementation of PPS. Results also show that nursing homes located in markets with higher Medicare managed care penetration and higher Medicare hospital discharges were more likely to offer subacute care services, while those located in markets with a higher proportion of home health agencies were less likely to offer subacute care. In conclusion, the change in Medicare reimbursement from cost-based to PPS resulted in a decrease in the supply of subacute care beds by nursing homes. However, the impact of PPS on nursing home’s subacute care has leveled off since 1997, suggesting this was a one-time effect.
Learning Objectives:
Keywords: Long-Term Care, Nursing Homes
Presenting author's disclosure statement:
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.