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APHA Scientific Session and Event Listing

Joan K. Davitt, MSS, MLSP, PhD, School of Social Policy and Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, 215-898-1592, jdavitt@sp2.upenn.edu

The Balanced Budget Act of 1997 altered the reimbursement structure for Medicare home health agencies under the fee for service program. Reimbursements were reduced to 1993 levels and such reductions may have encouraged agencies to alter the amount, duration or type of services provided to patients. This paper specifically summarizes findings related to utilization of home health care after implementation of the BBA and the differential impact of these policy changes on dually-eligible Medicare beneficiaries and those with available caregivers. The study consisted of a secondary analysis of the Medicare Current Beneficiary Survey and matching claims data for the years 1996 and 1998 (N=2,407) along with qualitative interviews of home health agency administrators. Using multivariate regression models with interaction terms, the researchers found that Medicare home health visits and reimbursements decreased significantly for Medicaid eligible patients. In addition, patients with greater caregivers saw a relative decrease in visits and reimbursements during this time. Qualitative interviews with agency administrators also showed that agencies increased their referrals to area agencies on aging, and increased caregiver education, training, and involvement in care in order to discharge patients sooner. Agency administrators also suggested that reductions in visits for Medicaid eligible patients did not mean a reduction in access to care. This pattern rather reflected a shifting in payment source for the home health care being provided. Implications regarding on going access to home health and in-home care in light of decreased state budgets and availability of informal support will be discussed.

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