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.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1001/jama.289.21.2841 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Prognostic Value of Frailty in Patients With Takotsubo Cardiomyopathy.
Clin Cardiol
January 2025
Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru.
Background: There is scarce data on the prognostic value of frailty in patients with Takotsubo cardiomyopathy (TCM). This study aimed to assess the association between frailty and in-hospital outcomes in patients with TCM.
Methods: Adult admissions with TCM were included using the 2016-2019 National Inpatient Sample database.
Non-Operative Management of Cholecystitis in Pregnant Patients Remains Common.
Surg Infect (Larchmt)
January 2025
Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA.
Cholecystectomy is the recommended treatment for acute cholecystitis in pregnancy, leading to fewer pregnancy-related complications than non-operative management. However, past research demonstrated high rates of non-operative management despite these recommendations. Rates of cholecystostomy tube usage and outcomes in pregnancy are not well described.
View Article and Find Full Text PDFProlonged Preservation of up to 24h at 10°C does not Impact Outcomes after Lung Transplantation.
Ann Surg
January 2025
Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
Objective: To determine the impact of prolonged storage of donor lungs at 10°C of up to 24h on outcome after lung transplantation.
Background: An increasing body of evidence suggests 10°C as the optimal storage temperature for donor lungs. A recent study showed that cold ischemic times can be safely expanded to >12h when lungs are stored at 10°C.
Associations With Adverse Postoperative Outcomes in Children Undergoing Atrial Septal Defect Closure in Lower-Resource Settings.
JACC Adv
December 2024
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.
Background: Atrial septal defects (ASDs) are a common cause of congenital heart disease worldwide.
Objectives: The purpose of the study was to assess change over time in surgical outcomes for ASD repair and identify patient-level risk factors for adverse postoperative outcomes.
Methods: We analyzed cases of isolated ASD in patients <18 years from 2010 to 2020 from 71 sites participating in the International Quality Improvement Collaborative for Congenital Heart Disease.
Demographics, psychiatric comorbidities, and hospital outcomes across eating disorder types in adolescents and youth: insights from US hospitals data.
Front Child Adolesc Psychiatry
May 2024
Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, United States.
Objective: The aim of our study was to delineate the differences in demographics, comorbidities, and hospital outcomes by eating disorder types in adolescents and transitional-age youth (15-26 years), and measure the association with psychiatric comorbidities.
Methods: We conducted a cross-sectional study using the nationwide inpatient sample (2018-2019) and included 7,435 inpatients (age 12-24 years) with a primary diagnosis of eating disorders: anorexia nervosa (AN, 71.7%), bulimia nervosa (BN, 4.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!