Impact of Medicare payment policy on home health resources utilization

Health Care Financing Review, Wntr, 1991 by Audrey Irvine, Elayne Kornblatt Phillips, Patricia Cloonan, James C. Torner, Mary E. Fisher, Gary A. Chase

These three groups were found to be significantly different in their referral source ([X.sup.2] = 26.87, df = 7, p = .003), length of hospital stay (F = 4.26, df = 2, p = .01, and prognosis ([X.sup.2] = 66.3, df = 14, p = .000). Hospital was the primary referral source for all three groups, followed by physician referrals for the Medicare and under 65 non-Medicare groups. The second most frequent referral source for the 65-or-over non-Medicare group was other sources such as neighbors, family, and social service agencies. Length of hospital stay was shortest for the young non-Medicare group and longest for the 65 or over non-Medicare sample. Not surprisingly, prognosis on referral was significantly better for the young non-Medicare sample. The two older groups differed significantly from one another on prognosis ([X.sup.2] = 15.8, p = .02); however, no consistent pattern was evident beyond a slightly worse prognosis for the older non-Medicare group. The three groups did not differ on gender.

Amount of services requested

Examination of the total number of nursing services requested yielded a significant three-group comparison (Table 2). The means suggest that the 65 or over non-Medicare sample was requesting one-third less nursing services on the average compared with either the under 65 non-Medicare or Medicare sample. For the frequency of nursing services requested, the two older groups looked more similar, requiring significantly less-frequent visits per week than the under 65 non-Medicare sample. This younger non-Medicare sample was requesting approximately one and one-third more visits per week than the older groups.

Services delivered

Significant differences were also found for services delivered. For both the number of visits received and nursing time consumed, the younger non-Medicare sample consumed more care. In each case, resources consumed by the 65 or over non-Medicare sample fell between the resources consumed by the Medicare and under the 65 non-Medicare samples. The mean differences in both cases were significantly different. The length of stay was also significantly different for the three groups. Surprisingly, it was the Medicare and under 65

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non-Medicare groups that were most similar. The 65 or over non-Medicare sample remained about 34.4 days longer in home health, a substantial increase in length of stay.

Specific nursing services requested

A three-group comparison of specific nursing service requests shows significant age-related trends for several of the services. The nursing services for which there were significant differences in requests are depicted on Figure 1. Significant differences in requests were found for Foley irrigation, Foley installation, venipuncture, vitamin B12 injections, teaching terminal illness care, wound care, diabetes education, and chest physiotherapy. The chi square in each case was significant (p<.003). The Medicare and 65 or over non-Medicare samples requested more Foley irrigation, venipuncture, and vitamin B12 injections, and less would care and diabetes education.