Length of Stay in Home Care Before and After the 1997 Balanced Budget Act

Abstract

CONTEXT: Prior to 1997, home health agencies (HHAs) were reimbursed on a fee-for-service basis and had incentives to provide more services. The 1997 Balanced Budget Act (BBA) reduced payments for home care services to help control Medicare spending. OBJECTIVE: To examine the length of stay in home care before and after the 1997 BBA. DESIGN AND SETTING: Cross-sectional study of home care patients in the 1996 and 1998 National Home and Hospice Care Surveys, which surveyed 1053 HHAs in 1996 and 1088 HHAs in 1998. PATIENTS: Nationally representative random sample of home care patients with Medicare coverage in 1996 (4127 patients) and 1998 (4051 patients). MAIN OUTCOME MEASURE: Length of stay in home care (based on the number of days a patient was enrolled in home care services). RESULTS: From 1996 to 1998, unadjusted median length of stay decreased by 16 days for all home care patients (60-44 days, P =.002). The decrease affected for-profit HHAs more than not-for-profit HHAs (111-55 days [51% decrease, P =.002] vs 46-36 days [22% decrease, P =.042]). In a Cox proportional hazards model of time to discharge from home care, post-BBA year (1998) was associated with a shorter length of stay in home care (adjusted hazard ratio [aHR] for home care discharge, 1.39 [95% confidence interval [CI], 1.19-1.61]), and for-profit status was associated with a longer length of stay in home care (aHR, 0.82 [95% CI, 0.71-0.94]) after adjusting for patient demographics, diagnoses, and functional status. CONCLUSION: After the 1997 BBA, length of stay in home care decreased among Medicare patients, particularly among those receiving care from for-profit HHAs.

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