Increasing home health service referrals, boon or bane?

E. G. Gay, J. J. Kronenfeld, S. L. Baker

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Discharges to home health services (HHS) increased dramatically for the elderly after Medicare's prospective payment system (PPS) was enacted in October 1983. A longitudinal study of fourth quarter South Carolina discharge abstracts from 68 of 71 short term acute care hospitals in the state were analyzed to appraise hospital responses to implementation of this significant change in Medicare's reimbursement system. PPS caused shifts in hospital practices as financial incentives radically changed from a cost-based system that encourages expenditures to a PPS that evokes conservation of resources within a hospital stay. In so doing, the "output" (i.e., discharge) changed. One of those changes observed was an increase in referrals to HHS. Apparently, capping the amount reimbursed for a particular diagnosis left the more resource-intensive patient vulnerable and in want of care on discharge. Demand for HHS rose significantly (+47% in 1983; +234% by 1985). Though a HHS referral may be appropriate during the recuperative phase of an illness, questions arise as to hospital motivation. The HHS referral represented the most resource-intensive, but arguably unprofitable segment. Had hospitals sought earlier discharges to "protect their bottom line" as reimbursement essentially was capped? Was a referral to HHS appropriate to meet the existing patient-care needs that remained? Did HHS offer a more cost-effective substitution for care formerly provided the patient in the hospital? What provider and consumer characteristics are at risk and why? Both consumer and provider concerns need to be addressed. Answers to these questions are most critical to future health care reform. Allocation decisions of scarce resources need to be grounded in realistic expectations drawn from appraisals of what does and does not work in the health care market.

Original languageEnglish (US)
Pages (from-to)49-67
Number of pages19
JournalHome Health Care Services Quarterly
Volume14
Issue number4
StatePublished - 1994
Externally publishedYes

Fingerprint

Health Services
Referral and Consultation
Prospective Payment System
Medicare
Motivation
Costs and Cost Analysis
State Hospitals
Health Care Sector
Health Care Reform
Health Expenditures
Longitudinal Studies
Length of Stay
Patient Care

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Gay, E. G., Kronenfeld, J. J., & Baker, S. L. (1994). Increasing home health service referrals, boon or bane? Home Health Care Services Quarterly, 14(4), 49-67.

Increasing home health service referrals, boon or bane? / Gay, E. G.; Kronenfeld, J. J.; Baker, S. L.

In: Home Health Care Services Quarterly, Vol. 14, No. 4, 1994, p. 49-67.

Research output: Contribution to journalArticle

Gay, EG, Kronenfeld, JJ & Baker, SL 1994, 'Increasing home health service referrals, boon or bane?', Home Health Care Services Quarterly, vol. 14, no. 4, pp. 49-67.
Gay, E. G. ; Kronenfeld, J. J. ; Baker, S. L. / Increasing home health service referrals, boon or bane?. In: Home Health Care Services Quarterly. 1994 ; Vol. 14, No. 4. pp. 49-67.
@article{6a2ed866930a490f80986cc7dccd1e8d,
title = "Increasing home health service referrals, boon or bane?",
abstract = "Discharges to home health services (HHS) increased dramatically for the elderly after Medicare's prospective payment system (PPS) was enacted in October 1983. A longitudinal study of fourth quarter South Carolina discharge abstracts from 68 of 71 short term acute care hospitals in the state were analyzed to appraise hospital responses to implementation of this significant change in Medicare's reimbursement system. PPS caused shifts in hospital practices as financial incentives radically changed from a cost-based system that encourages expenditures to a PPS that evokes conservation of resources within a hospital stay. In so doing, the {"}output{"} (i.e., discharge) changed. One of those changes observed was an increase in referrals to HHS. Apparently, capping the amount reimbursed for a particular diagnosis left the more resource-intensive patient vulnerable and in want of care on discharge. Demand for HHS rose significantly (+47{\%} in 1983; +234{\%} by 1985). Though a HHS referral may be appropriate during the recuperative phase of an illness, questions arise as to hospital motivation. The HHS referral represented the most resource-intensive, but arguably unprofitable segment. Had hospitals sought earlier discharges to {"}protect their bottom line{"} as reimbursement essentially was capped? Was a referral to HHS appropriate to meet the existing patient-care needs that remained? Did HHS offer a more cost-effective substitution for care formerly provided the patient in the hospital? What provider and consumer characteristics are at risk and why? Both consumer and provider concerns need to be addressed. Answers to these questions are most critical to future health care reform. Allocation decisions of scarce resources need to be grounded in realistic expectations drawn from appraisals of what does and does not work in the health care market.",
author = "Gay, {E. G.} and Kronenfeld, {J. J.} and Baker, {S. L.}",
year = "1994",
language = "English (US)",
volume = "14",
pages = "49--67",
journal = "Home Health Care Services Quarterly",
issn = "0162-1424",
publisher = "Routledge",
number = "4",

}

TY - JOUR

T1 - Increasing home health service referrals, boon or bane?

AU - Gay, E. G.

AU - Kronenfeld, J. J.

AU - Baker, S. L.

PY - 1994

Y1 - 1994

N2 - Discharges to home health services (HHS) increased dramatically for the elderly after Medicare's prospective payment system (PPS) was enacted in October 1983. A longitudinal study of fourth quarter South Carolina discharge abstracts from 68 of 71 short term acute care hospitals in the state were analyzed to appraise hospital responses to implementation of this significant change in Medicare's reimbursement system. PPS caused shifts in hospital practices as financial incentives radically changed from a cost-based system that encourages expenditures to a PPS that evokes conservation of resources within a hospital stay. In so doing, the "output" (i.e., discharge) changed. One of those changes observed was an increase in referrals to HHS. Apparently, capping the amount reimbursed for a particular diagnosis left the more resource-intensive patient vulnerable and in want of care on discharge. Demand for HHS rose significantly (+47% in 1983; +234% by 1985). Though a HHS referral may be appropriate during the recuperative phase of an illness, questions arise as to hospital motivation. The HHS referral represented the most resource-intensive, but arguably unprofitable segment. Had hospitals sought earlier discharges to "protect their bottom line" as reimbursement essentially was capped? Was a referral to HHS appropriate to meet the existing patient-care needs that remained? Did HHS offer a more cost-effective substitution for care formerly provided the patient in the hospital? What provider and consumer characteristics are at risk and why? Both consumer and provider concerns need to be addressed. Answers to these questions are most critical to future health care reform. Allocation decisions of scarce resources need to be grounded in realistic expectations drawn from appraisals of what does and does not work in the health care market.

AB - Discharges to home health services (HHS) increased dramatically for the elderly after Medicare's prospective payment system (PPS) was enacted in October 1983. A longitudinal study of fourth quarter South Carolina discharge abstracts from 68 of 71 short term acute care hospitals in the state were analyzed to appraise hospital responses to implementation of this significant change in Medicare's reimbursement system. PPS caused shifts in hospital practices as financial incentives radically changed from a cost-based system that encourages expenditures to a PPS that evokes conservation of resources within a hospital stay. In so doing, the "output" (i.e., discharge) changed. One of those changes observed was an increase in referrals to HHS. Apparently, capping the amount reimbursed for a particular diagnosis left the more resource-intensive patient vulnerable and in want of care on discharge. Demand for HHS rose significantly (+47% in 1983; +234% by 1985). Though a HHS referral may be appropriate during the recuperative phase of an illness, questions arise as to hospital motivation. The HHS referral represented the most resource-intensive, but arguably unprofitable segment. Had hospitals sought earlier discharges to "protect their bottom line" as reimbursement essentially was capped? Was a referral to HHS appropriate to meet the existing patient-care needs that remained? Did HHS offer a more cost-effective substitution for care formerly provided the patient in the hospital? What provider and consumer characteristics are at risk and why? Both consumer and provider concerns need to be addressed. Answers to these questions are most critical to future health care reform. Allocation decisions of scarce resources need to be grounded in realistic expectations drawn from appraisals of what does and does not work in the health care market.

UR - http://www.scopus.com/inward/record.url?scp=0028313007&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028313007&partnerID=8YFLogxK

M3 - Article

C2 - 10134030

AN - SCOPUS:0028313007

VL - 14

SP - 49

EP - 67

JO - Home Health Care Services Quarterly

JF - Home Health Care Services Quarterly

SN - 0162-1424

IS - 4

ER -