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Nelda McCall

Publications and source records attributed to Nelda McCall.

7 recordsLinked to original sources
PubMed2004

Decreased home health use: does it decrease satisfaction?

This study investigates differences in satisfaction and quality of life for Medicare beneficiaries using home health care services before and after implementation of the Interim Payment System (IPS) as part of the Balanced Budget Act (BBA) of 1997. Data are from surveys conducted pre- and post-BBA. Multivariate analyses estimate the effect of being in the post-BBA period controlling for beneficiary, agency, and community characteristics. Sixteen dependent variables measure satisfaction with the agency, and two measure life quality. Despite dramatic utilization decreases, differences were not found for overall agency satisfaction, satisfaction with discharge, or with the nursing and therapist care received. Decreases in satisfaction were found for some interpersonal aspects of staff interaction and, for the group of respondents who received services in the agencies that participated in both the pre- and postperiods, with the decreased provision of personal care services. A large increase was found in staff encouraging independence.

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PubMed2003

Reforming Medicare payment: early effects of the 1997 Balanced Budget Act on postacute care.

The 1997 Balanced Budget Act (BBA) reformed payment for Medicare postacute services. This article examines postacute care use just before and immediately after implementation of the BBA for hospital discharges for five diagnosis-related groups that commonly use postacute care. Changes in treatment patterns were more beneficiaries receiving no postacute care, much less use of home health services both initially and after initial institutional postacute care, and slightly more use of rehabilitation and long-term care hospitals. But no consistent increases in adverse outcomes were observed using logistic regression models. These results demonstrate that financing changes can affect use patterns, that less use does not automatically imply poorer quality, and that the interrelationship of services should be considered when designing reimbursement methodologies.

Budgets↗
PubMed2003

Utilization of home health services before and after the Balanced Budget Act of 1997: what were the initial effects?

OBJECTIVE: To estimate the impact of the Balanced Budget Act of 1997 (BBA), which changed the way Medicare reimbursed for home health services, on a range of home health utilization measures, and to examine whether particular subgroups of beneficiaries were differentially impacted in the post-BBA period. DATA SOURCES: Secondary data from the Centers for Medicare and Medicaid Services (CMS) Standard Analytic Files for the 1 percent sample of Medicare beneficiaries for fiscal years 1997 and 1999, linked with information from CMS eligibility, provider, and cost report files as well as the Area Resources File. STUDY DESIGN: Logistic regression was used to estimate the effects of being in the post-BBA period on the incidence of home health service use and ordinary least squares (OLS) regression was used to estimate the effects of being in the post-BBA period on the amount and type of use by home health service users. Interaction terms we reincluded for all the independent variables to assess whether the effect was disproportionate among particular beneficiary subgroups. PRINCIPAL FINDINGS: Results show a 22 percent decrease in the percentage using home health services post-BBA and a 39 percent decrease in the number of visits per user. Stronger reductions, though not very large, were found in the incidence of use for beneficiaries aged 85 and older, those in states with high historical Medicare home health use, and those with Medicaid buy-in. More intensive reductions in the number of services were found for those aged 85 and older, in high historical Medicare use states, nonwhites, females, those using for-profit agencies, and those treated for certain diagnoses. Less intensive reductions were associated with hospital-based agencies. CONCLUSIONS: This research demonstrates that public program expenditures can be sharply curtailed with financial incentives. As reimbursement shifts to a prospective payment system legislated by the BBA, utilization should be closely monitored, especially for vulnerable subgroups.

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PubMed2003

The impact of Medicare home health policy changes on Medicare beneficiaries.

This brief presents results from an analysis of how a new payment system -- the Interim Payment System (IPS) - mandated by the 1997 Balanced Budget Act (BBA) affected Medicare home health service use and beneficiary outcomes. The study found that the IPS had a considerable impact on home health utilization, causing reductions in the overall proportion of Medicare beneficiaries who received the service; the number of home health visits per home health user; the average length of a home health episode of care; and overall Medicare home health expenditures. The study also examined the impact of these reductions on outcomes experienced by Medicare beneficiaries. Evidence presented in this brief shows that, overall, the impact of the IPS on beneficiary outcomes was minimal. Moreover, it appears that service reductions did not cause significant increases in the use of other types of post-acute care.

Budgets↗
PubMed2002

Constraining Medicare home health reimbursement: what are the outcomes?

The implementation of the Balanced Budget Act (BBA) of 1997 resulted in substantial decreases in the amount of Medicare home health use. Use among home health users decreased by two-fifths from fiscal year (FY) 1997, just before the passage of the BBA to FY 1999, the first full year after the implementation of the home health interim payment system. This article examines whether these dramatic reductions in use resulted in increased incidence of potential adverse outcomes, i.e., increases in hospitalizations, skilled nursing home facility admissions, emergency room (ER) use, or death among home health users.

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PubMedDate not supplied

Trends in Medicare home health care use: 1997-2001.

The Balanced Budget Act of 1997 mandated a major overhaul in Medicare payment for home health care with an interim payment system (IPS) preceding a prospective payment system (PPS). This study extends an earlier analysis of the impact of the IPS to determine whether home health use and spendingtrends changed after the introduction of the PPS. The rapid decline in the incidence of use and visits per user under the IPS slowed in its final year and then picked up again in the first year of the PPS. In addition, average payment per visit increased sharply under the PPS. Little is known about the impact of continued large reductions in home health services since 1999.

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