Post-Hospital Care:

Efforts To Evaluate Medicare Prospective Payment Effects Are Insufficient

PEMD-86-10: Published: Jun 2, 1986. Publicly Released: Jun 2, 1986.

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In response to a congressional request, GAO: (1) examined the Health Care Financing Administration's (HCFA) methods for evaluating the Medicare Prospective Payment System's (PPS) effect on post-hospital services; and (2) developed a plan to determine these effects.

GAO found that: (1) the studies the Department of Health and Human Services (HHS) is conducting on PPS will produce limited information on changes in the use of and expenditures for Medicare-covered post-hospital services; and (2) HHS has no plans to develop information on whether the changes it measures are due to PPS and what effects PPS has on Medicare beneficiaries and post-hospital services. GAO developed a two-part plan for evaluating the effects of the system on post-hospital care, which would use time-series analysis and data compiled before and after PPS implementation.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: Work on the MADRS file was given priority by HCFA, and 1985 data will be available in June 1987, with 1986 and 1984 data to be available shortly thereafter. However, MADRS will include less complete bill information, and will not include pre-PPS data, which GAO believes reduces the utility of the file for research purposes. Actions in progress should provide the basic information recommended.

    Recommendation: The Secretary of Health and Human Services should direct the Administrator, HCFA, to undertake interrupted time-series studies using data available from the Medicare Statistical System to determine some of the effects of PPS on post-hospital care. In particular, information can and should be developed about its effects on the use of and expenditures for post-hospital skilled nursing home and home health care services, and on readmissions to Medicare-covered facilities and mortality rates for episodes of illness beginning with a hospitalization.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Not Implemented

    Comments: Further changes to the structure of the MADRS file are not feasible. The development of a new data system, PRISM, should make the intended improvements.

    Recommendation: The Secretary of Health and Human Services should direct the Administrator, HCFA, to expedite the completion of the Medicare Automated Data Retrieval System that will reorganize the Medicare administrative data into a data file which is better able to support research and evaluation activities than are the current files.

    Agency Affected: Department of Health and Human Services

 

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