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APHA Scientific Session and Event Listing

Huai-Che Shih, MS, Bruce Friedman, PhD, MPH, and Helena Temkin-Greener, 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: The Medicare home health care prospective payment system (PPS), which took effect in October 2000, assigns patients to a pre-determined rate schedule, the Home Health Resource Group (HHRG), based on their clinical, functional, and services utilization characteristics. A recent study observed a shift in the HHRG distribution toward more clinically complex and functionally dependent patients post PPS. However, since this HHRG measure could be directly influenced by PPS financial incentives, this shift could also result from changes in reporting accuracy or attempts to game the payment system. Our study uses data and measures unrelated to PPS financial incentives to examine the actual impact of PPS on Medicare home health care patient case-mix.

Methods: We compared the Medical Expenditure Panel Survey data from two pre-PPS years (1997 and 1998) and two post-PPS years (2001 and 2002). Patient case-mix was defined using risk scores derived from the CMS-HCC risk-adjustment model.

Results: 3,553 Medicare home health patient-months were identified. We detected a significant increase (p<0.001) in the CMS-HCC risk score post PPS. Results from an Ordinary Least Squares model (adjusted for demographic covariates, using sampling weights and clustered by each patient's individual identifier) shows that PPS status was positively associated (p<0.001) with the CMS-HCC risk score.

Conclusions: Using the CMS-HCC risk score as the risk measure, the patient case-mix of Medicare home health care does appear to have significantly increased post PPS. Additional studies are needed to further investigate the shift in home health care financing and case-mix distribution post PPS.

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, and
• identify significant research topics relating to this issue.

Keywords: Medicare, Home Care

Presenting author's disclosure statement:

Not Answered