Unbiased Analysis of Today's Healthcare Issues
Today I review Medicare’s approach for paying for outpatient therapy visits. The content draws largely from CMS and MedPAC sources. What is outpatient therapy Outpatient therapy includes physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services. Who can provide outpatient therapy? Institutional Facilities Hospitals Skilled nursing facilities (SNF) Comprehensive outpatient rehabilitation facilities (CORF)…
Shrinkage estimators (such as the James-Stein estimator) are well-known in the economics literature and have a number of applications. A recent paper by Shwartz et al. 2012 demonstrates how one could apply shrinkage estimators to measure nursing home quality. “A challenge when examining individual QIs across a range of facilities is that sample sizes are…
A number of studies have already examined this question. Baker et al. (2003) examined the effectiveness of a public reporting effort in hospitals in Ohio, finding little relationship between a hospital’s report card ranking and changes in its market share. Cutler et al. (2004) examined the effects of reporting quality information about cardiac surgery on…
The movement of mental health care from mental hospitals to treatment in outpatient settings and nursing homes began in the 1950s. Here is how it happened. “The field of medicine where the ‘rediscovery of community’ found an immediately welcome reception was mental health services. A movement away from mental hospitals had already begun in the…
For nursing homes at least, patients do not seem to have much choice. According to an article by Grabowski and Town: The introduction of the NHQI was generally unrelated to facility quality and consumer demand. However, nursing homes facing greater competition improved their quality more than facilities in less competitive markets…The lack of competition in…
Today I summarize recent trends in skilled nursing facilities (SNFs) as outlined in MedPAC’s 2011 Report to Congress. SNFs furnish short-term skilled nursing and rehabilitation services to beneficiaries after a stay in an acute care hospital. These services include physical and occupational therapy and speech–language pathology services. Examples of SNF patients include those recovering from…
Hospitals in Sacramento were concerned about the large number of nusring home transfers to its facility. Were many of these tranfers unnecessary? Did patients with little chance of recovery benefit from these hospital stays? To reduce end-of-life tranfers to hospitals from nursing homes, 3 Sacramento-area hospital systems and 18 nursing homes instuted the Preparing Residents…
Inpatient Rehabilitation Facilities (IRF) provide rehabilitation to invidiuals recovering from serious illnesses such as strokes or hip replacements. Today I review MedPAC’s analysis of Medicare payment policies for IRFs. In 2002, expenditures on IRF totaled nearly $5.7 billion. This figure grew at an annual rate of 6.7 percent to $6.4 billion in 2004. Between 2005…
On the importance of Nursing homes: “More than 1.5 million people reside in U.S. nursing homes at a cost of more than $120 billion per year (Kaiser Family Foundation, 2007). Medicaid is the majority payer of nursing home services, giving indigent people access to nursing home care by directly reimbursing facilities for the care of…
More than 3 million frail and disabled individuals rely on nursing home services in any given year. About half of these individuals consider the nursing home to be their primary place of residence. Nursing home quality, however, has often been called into question. Some experts believe pay-for-performance schemes will improve nursing home quality. Today, I…