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Impact of the Home Health PPS on Access in Rural America
This study is designed to provide information on how the shift to prospective payment has affected access to home care in rural communities. The home health prospective payment system (PPS) was implemented in October 2000 to reduce growth in Medicare home health expenditures. Under the PPS, home care agencies are reimbursed based on a 60-day episode of care, with adjustments to the base payment that reflect differences in resource needs. This case-mix adjustment classifies home health patients into Home Health Resource Groups (HHRGs) based on their clinical characteristics, functional status, and service utilization. This study is designed to provide information on how the shift to prospective payment has affected access to home care in rural communities. This study will explore the impact of the PPS on patterns of home health utilization. The following research questions will be examined:
- How do the demographic and clinical characteristics of rural and urban Medicare beneficiaries who received home care prior to the PPS compare to those who received home care following the PPS?
- Are there subgroups of rural and urban beneficiaries for whom access to home care is more limited following implementation of the PPS? For whom home care is more accessible following implementation of the PPS?
- To what extent has the PPS had an effect on patterns of home care utilization?
- Has the quality of care provided to home care users been affected by the PPS?
Data to conduct this study will be obtained from the 5 percent MEDPAR file and the Home Health 5-percent Standard Analytical File.
Publications
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Utilization of Home Health Services Among Rural Medicare Beneficiaries Before and After the PPS
Author(s): Janet P. Sutton
Date: 08 / 2005
Describes a study conducted to gather information on the rural effects of the PPS, including whether the PPS contributed to changes in: (1) the demographic and clinical characteristics of home care users; (2) the likelihood of using each of six home care disciplines (aide, skilled nursing, physical therapy, occupational therapy, speech therapy and medical social work); and (3) the intensity of services. A total of 99,367 home health episodes were represented in the two years of Medicare data examined. In both study years, urban residents accounted for three-quarters of episodes, while residents of large rural counties and those of remote rural counties accounted for approximately 21 percent and 3 percent of episodes, respectively. Findings suggest that the PPS has had a mixed effect on access to home care in rural counties. Study results indicated an association between implementation of the PPS and admitting home health diagnoses, utilization and intensity of home care episodes and, for the subset of home health users admitted from an acute hospital, readmission rates.
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