IPS causes reduction in care, fewer resources
IPS causes reduction in care, fewer resources
Study highlights system’s problems
A new study’s findings about the impact the interim payment system (IPS) show that most home care agencies have altered their case mix and practice patterns to conform utilization to reimbursement. That has resulted in reduced care for diabetics and other patients who have chronic, long-term health care needs.
The study, "An Examination of Medicare Home Health Services: A Descriptive Study of the Effects of the Balanced Budget Act Interim Payment System on Access to and Quality of Care," presents a stark glimpse of the consequences of the Balanced Budget Act of 1997.
The results, please
George Washington University of Washington, DC, conducted the study of 28 home care agencies in nine states — California, Florida, Indiana, Iowa, Louisiana, Massachusetts, Mississippi, Pennsyl-vania, and Texas. Each agency answered 60 questions regarding data from 1994, 1996, and 1998 about their types of patients admitted to care, patient mix over time, patterns of referrals and discharges, clinical practice patterns, and changes in demand for alternative services and financing.
The participating agencies included nine freestanding, for-profit agencies; 11 freestanding non-profit agencies; and eight hospital-based or affiliated agencies.
Here are some of the study’s findings:
• Southern agencies were more likely to reduce the level of services, since they apparently had a case mix with more chronic illnesses and were less able to change that.
•Agencies in other regions often relied on screening admission of patients and altering market patterns to control case mix of patients, and would reduce the number of visits.
• Complex diabetics were significantly affected by both exclusions from care and reductions in the level of services.
• Patients with predictably low costs appeared to experience improved access to care, regardless of amount of time in care.
• Most agencies said the financial pressure to limit services has created greater fragmentation of care between different types of providers.
• The number of Medicare patients admitted to the study agencies as a percentage of all patients has declined 21% since 1996, and Medicare 1998 revenues have declined by 25% from 1994 levels.
• Some agencies said IPS has triggered some efficiencies and quality enhancements, including more case management, higher levels of nursing supervision, more goal and outcomes orientation with patients, reduction of administrative costs, and teaching patients greater independence.
• Nearly all of the agencies studied said they have cut staff, resulting in a 23% reduction in skilled nursing staff since 1994.
(Editor’s note: For a summary of the report and more information about IPS, see the National Association for Home Care’s Web site at: www.nahc.org/NAHC/ NewsInfo/99nr/gwrpt.html.)
Sources
• Charlene Berges, BSN, RN, Director, Golden Belt Home Health and Hospice of St. Catherine Hospital, 1133 Kansas Plaza, Garden City, KS 67846. Telephone: (316) 272-2519.
• Donna Larkin, Media Relations Specialist/Spokes-woman, Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Telephone: (630) 792-5914.
• Martha McCabe, Administrator, Susan B. Allen Memorial Hospital Home Health, 720 W. Central Ave., El Dorado, KS 67042. Telephone: (316) 321-3300.
• Lisa Munnerlyn, Administrator, Community Home Health Services, Inc., 3360 E. Livingston Ave., Suite 1B, Columbus, OH 43227. Telephone: (614) 237-3540.
• National Association for Home Care, 228 Seventh St. S.E., Washington, DC 20003. Telephone: (202) 547-7424. Fax: (202) 547-3540. Web site: www.nahc.org.
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