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APHA Scientific Session and Event Listing

Huai-Che Shih, MS, Helena Temkin-Greener, PhD, MPH, and Bruce Friedman, PhD, MPH. Department of Community and Preventive Medicine, University of Rochester, 601 Elmwood Avenue Box 644, Rochester, NY 14642, (585) 275-3432, huai-che_shih@urmc.rochester.edu

Objectives: Medicare/Medicaid dual beneficiaries are poorer, sicker, and cost Medicare 60% more than non-dual enrollees. The Medicare home health care (HHC) prospective payment system (PPS), which took effect in October 2000, changed the way Medicare reimburses HHC providers by adjusting payments for clinical, functional and services utilization characteristics of patients. To date, several studies have observed, and attributed to PPS, an increase in the severity of Medicare HHC users. They also have shown a decline in the number of visits per user. However, little is known about the changes in case-mix, utilization, and distribution of payment sources for beneficiaries who are dually eligible for Medicare and Medicaid. We examine the changes in financing distribution and service intensity of HHC used by the dual beneficiaries to investigate possible substitution between Medicare and Medicaid as a result of PPS.

Methods: We compared Medical Expenditure Panel Survey (MEPS) data from two pre-PPS (1997 and 1998) and two post-PPS years (2001 and 2002). Service intensity was measured by the number of HHC visits per month, and patient case-mix derived from the CMS-HCC risk-adjustment model. Financing distribution was measured by the proportion of HHC expenditures for each payment source. For each patient-month, primary payment source was identified as Medicare or Medicaid. All estimates were adjusted for statistical sampling weights.

Results: 5,086 HHC patient-months (mean age 72.43 years old, 25.44% male, 33.54% non-white) of Medicare/Medicaid dual beneficiaries were identified. We observed a significant increase (0.6887 to 0.8858, p=0.004) in the CMS-HCC risk score when HHC services were paid by Medicare, and no significant increase (0.7373 to 0.8006, p=0.252) when Medicaid was the primary payer. The number of HHC visits per month significantly decreased from 15.70 to 12.30 (p=0.035) when covered by Medicare, while number in HHC paid by Medicaid increased (16.35 to 18.56, p=0.108). The share of HHC expenditures financed by Medicare decreased from 19.81% to 16.42% (p=0.429) while that of Medicaid increased from 46.68% to 72.43% (p=0.002).

Conclusions: These findings suggest that a substitution has occurred post PPS in HHC paid by Medicare and Medicaid. Medicare HHC users show increased severity. While Medicaid appears to care for lower acuity patients, its share of payments among the dual beneficiaries significantly increased post PPS. This apparent shift in financing distribution of HHC has important implications for State Medicaid programs, providers and patients.

Learning Objectives:

At the conclusion of the session, the participant will be able to
• recognize the changes in Medicare home health care policy,
• evaluate its consequences on Medicare/Medicaid dual beneficiaries, and
• identify significant research topics relating to this issue.

Keywords: Medicare/Medicaid, Home Care

Presenting author's disclosure statement:

Any relevant financial relationships? No