How long did they go? : prospectively paid agencies contiune to reduce service use : final report

103 Pages·2001·3.4 MB·English

by  Archibald, Nancy

ContractNo.: 500-94-0062 MATHEMATICA
MPRReferenceNo.: 8246-210
PolicyResearch,Inc.
HowLongDidTheyGo?
ProspectivelyPaid CMSLibrary
AgenciesContinueto 30 7500CS2e-c0u7ri-t1y3Slv4
ReduceServiceUse Baltimore,MD21244
FinalReport
April19,2001
NancyArchibald
ValerieCheh
Submittedto: Submittedby:
HealthCareFinancingAdministration MathematicaPolicyResearch,Inc.
7500SecurityBoulevard,(C-3-21-06) P.O.Box2393
Baltimore,MD21244-1850 Princeton,NJ 08543-2393
Telephone: [phone]
ProjectOfficer: Facsimile: [phone]
AnnMeadow
ProjectDirector:
ValerieCheh

ACKNOWLEDGMENTS
Inpreparingthisreport,wereceivedtheassistanceofmanyofourMPRcolleagues,forwhich
wearethankful. ChrisTrenholmmademajorcontributionsthroughhispreviousreportonservice
useandhisguidanceonthestatisticalmethodologyforthepresentreport. AmyZambrowski
providedprogrammingsupervision,whileWillBlack,RobertLetzlerandJeffreyMeltzerprovided
directprogrammingsupport. BobSchmitzcontributedthoughtfulcriticalreviews. RoyGrisham
editedandJaneNelsonproducedthisreportwiththeassistanceofMarjorieMitchell. Theauthors
areresponsibleforanyerrorsoromissions.
in

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CONTENTS
Chapter Page
EXECUTIVESUMMARY xiii
I THEPER-EPISODEHOMEHEALTHDEMONSTRATIONAND
EVALUATION 1
A. THEMEDICAREHOMEHEALTHBENEFIT 1
B. THEPER-EPISODEDEMONSTRATION 2
C. SUMMARYOFPREVIOUSFINDINGS 3
D. SUMMARYOFCURRENTFINDINGS 4
II DATAANDMETHODS 5
A. CONSTRUCTINGTHEMAINDATAFILE 5
1 IdentifyingIndividualPatientEpisodes(Records) 5
2. CreatingOutcomeVariables 6
3. CreatingControlVariables 7
B. FORMINGTHESAMPLEFORTHEANALYSISOFIMPACTS 7
1 ExcludingAgencies 10
2. ExcludingIndividualAdmissions 10
3. ExcludingSubsequentPatientEpisodes 13
4. AnalysisSample 14
C. SUMMARYSTATISTICSFORTHEMAINCONTROLVARIABLES
INTHEIMPACTANALYSIS 14
1. CharacteristicsoftheSample 15
2. ImplicationsfortheAnalysis 22
D. UNITOFANALYSISFORMEASURINGDEMONSTRATION
IMPACTS 22
..
CONTENTS(continued)
Chapter Page
n E. STATISTICALTECHNIQUESFORMEASURING
(Continued) DEMONSTRATIONIMPACTS 23
1 EstimatingImpactsBetweenDemonstrationYears 23
2. EstimatingSubgroupImpacts 25
3. HypothesisTestsfortheImpactEstimates 28
F. DESCRIBINGLONG-STAYPATIENTS 28
1 FormingtheSamplefortheLong-StayAnalysis 29
2. DescriptiveMethodsforLong-StayAnalysis 30
III IMPACTOFPROSPECTIVEPAYMENTONSERVICEUSE:
TRENDSOVERTHEFULLDEMONSTRATION 31
A. PRIORFINDINGS 31
B. EXPECTEDTRENDS 33
C. OVERALLIMPACTS 34
1. TotalNumberofVisitsProvided 35
2. NumberofVisitsbyType 41
3. ProbabilityofReceivingCertainTypesofVisits 42
4. EpisodeLength 45
D. SUBGROUPIMPACTS 47
E. ROBUSTNESSTESTS 50
SUMMARY
F. 53
IV ANALYSISOFLONG-STAYPATIENTS 55
A. THELONG-STAYSAMPLE 56
B. RESULTS 58
1. DidLongStayPatientsRemainaLargePartofHomeCare? 58
vi
CONTENTS(continued)
Chapter Page
IV 2. WhatWeretheCharacteristicsofLong-StayPatients? 60
(Continued)
C. SUMMARY 63
V DISCUSSIONOFFINDINGS 67
A. KEYFINDINGS 67
B. LIMITATIONSOFTHEANALYSIS 69
C. POLICYIMPLICATIONS 71
1. ImplicationsoftheServiceUseReductions 71
2. ImplicationsoftheAnalysisofLong-TermStayers 71
REFERENCES 73
APPENDIXA A.l
vn

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TABLES
Table Page
II.1 AOFUTTECROAMDEMVIASRSIIAOBNLTEOSADEDSECMROINBSITNRGAMTEIDOINCAHROEMESEHREVAICLETHUSE
AGENCY 8
11.2 CONTROLVARIABLESFORMAINMULTIVARIATEANALYSIS,
BYSOURCE 9
11.3 AGENCYDATAEXCLUDEDFROMANALYSISSAMPLE,BY
TREATMENTSTATUS 11
11.4 PATIENTADMISSIONSRECORDSEXCLUDEDFROMANALYSIS
SAMPLE,BYTREATMENTSTATUS 12
11.5 WEIGHTEDMEANSFORPATIENT-LEVELCONTROLVARIABLES,
BYTREATMENTSTATUS,ANDTESTSFORDIFFERENCESIN
TREATMENTANDCONTROLGROUPMEANS 16
11.6 WEIGHTEDMEANSFORAGENCY-LEVELANDAREA-LEVEL
CONTROLVARIABLES,BYTREATMENTSTATUS,ANDTESTS
FORDIFFERENCESINTREATMENTANDCONTROLGROUP
MEANS 20
III.1 NUMBEROFVISITSPROVIDEDINTHEAT-RISKPERIOD,TOTAL
ANDBYSERVICETYPE 36
111.2 AVERAGENUMBEROFVISITSPROVIDEDBYCONTROLGROUP
AGENCIES,CONTROLLINGFORPATIENTCHARACTERISTICS 37
111.3 CUMULATIVENUMBEROFVISITSPROVIDEDINTHEAT-RISK
PERIOD 38
111.4 PROBABILITYOFRECEIVINGAGIVENSERVICEDURINGTHE
AT-RISKPERIOD,BYTREATMENTSTATUS 43
111.5 CUMULATIVEPERCENTAGEOFEPISODESENDEDINEACH
MONTHOFTHEAT-RISKPERIOD,BYTREATMENTSTATUS 46
111.6 IMPACTSOFPROSPECTIVEPAYMENTONSERVICEUSE,BY
WHETHERTHEAGENCYHASAHIGH-USEORLOW-USE
PRACTICEPATTERN 48
111. IMPACTSOFPROSPECTIVEPAYMENTUNDERALTERNATE
MODELS 52
ix
TABLES(continued)
Table Page
IV.1 DEMOGRAPHICCHARACTERISTICSOFLONG-STAYPATIENTS 61
IV.2 RESOURCEUSECHARACTERISTICSOFLONG-STAYPATIENTS 62
IV.3 PERCENTOFLONG-STAYPATIENTSWITHSELECTEDCOMMON
CONDITIONSASPRIMARYDIAGNOSISATADMISSION 64