Bridging Disciplinary Boundaries (January 11 - 14, 2007)

The Balanced Budget Act of 1997 established an Interim Payment System (IPS) which altered reimbursements (both amount and structure) for Medicare home health agencies serving fee for service beneficiaries. Reimbursements were reduced to 1993 levels and per-beneficiary capitated limits were introduced in the traditional home health benefit for the first time. Such changes encouraged agencies to alter the amount, duration or type of services provided to patients. This paper specifically summarizes findings related to utilization of home health care after implementation of the BBA and the differential impact of these policy changes on dually-eligible Medicare beneficiaries and those with available caregivers. The study consisted of a secondary analysis of the Medicare Current Beneficiary Survey and matching claims data for the years 1996 (pre-IPS) and 1998 (IPS) (N=2,407) along with qualitative interviews of home health agency administrators. Using multivariate regression models with interaction terms, the researchers found that Medicare home health visits and reimbursements decreased significantly for Medicaid eligible patients between 1996 and 1998. In addition, patients with greater caregivers saw a relative decrease in visits and reimbursements during this time. Qualitative interviews with agency administrators also showed that agencies increased their referrals to area agencies on aging, and increased caregiver education, training, and involvement in care in order to discharge patients sooner. Agency administrators also suggested that reductions in visits for Medicaid eligible patients did not mean a reduction in access to care. This pattern rather reflected a shift in payment source from Medicare to Medicaid for the home health care being provided. The role of social work in ensuring ongoing access to home care services in light of decreased state budgets will be discussed. Strategies for interdisciplinary cooperation in the home care setting to ensure safe transitions between formal and informal care will be presented.