TY  - JOUR
T1  - LEngth of stay in home care before and after the 1997 balanced budget act
AU  - Murkofsky RL, Phillips RS, McCarthy EP, Davis RB, Hamel M
Y1  - 2003/06/04
N1  - 10.1001/jama.289.21.2841
JO  - JAMA
SP  - 2841
EP  - 2848
VL  - 289
IS  - 21
N2  - Context 
                  Prior to 1997, home health agencies (HHAs) were reimbursed on a fee-for-service
basis and had incentives to provide more services. The 1997 Balanced Budget
Act (BBA) reduced payments for home care services to help control Medicare
spending.Objective 
                  To examine the length of stay in home care before and after the 1997
BBA.Design and Setting 
                  Cross-sectional study of home care patients in the 1996 and 1998 National
Home and Hospice Care Surveys, which surveyed 1053 HHAs in 1996 and 1088 HHAs
in 1998.Patients 
                  Nationally representative random sample of home care patients with Medicare
coverage in 1996 (4127 patients) and 1998 (4051 patients).Main Outcome Measure 
                  Length of stay in home care (based on the number of days a patient was
enrolled in home care services).Results 
                  From 1996 to 1998, unadjusted median length of stay decreased by 16
days for all home care patients (60-44 days, P =
.002). The decrease affected for-profit HHAs more than not-for-profit HHAs
(111-55 days [51% decrease, P = .002] vs 46-36 days
[22% decrease, P = .042]). In a Cox proportional
hazards model of time to discharge from home care, post-BBA year (1998) was
associated with a shorter length of stay in home care (adjusted hazard ratio
[aHR] for home care discharge, 1.39 [95% confidence interval {CI}, 1.19-1.61]),
and for-profit status was associated with a longer length of stay in home
care (aHR, 0.82 [95% CI, 0.71-0.94]) after adjusting for patient demographics,
diagnoses, and functional status.Conclusion 
                  After the 1997 BBA, length of stay in home care decreased among Medicare
patients, particularly among those receiving care from for-profit HHAs.
SN  - 0098-7484
M3  - doi: 10.1001/jama.289.21.2841
UR  - http://dx.doi.org/10.1001/jama.289.21.2841
ER  -