Effects of payment changes on trends in post-acute care

Health Serv Res. 2009 Aug;44(4):1188-210. doi: 10.1111/j.1475-6773.2009.00968.x. Epub 2009 Apr 5.


Objective: To test how the implementation of new Medicare post-acute payment systems affected the use of inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies.

Data sources: Medicare acute hospital, IRF, and SNF claims; provider of services file; enrollment file; and Area Resource File data.

Study design: We used multinomial logit models to measure realized access to post-acute care and to predict how access to alternative sites of care changed in response to prospective payment systems.

Data extraction methods: A file was constructed linking data for elderly Medicare patients discharged from acute care facilities between 1996 and 2003 with a diagnosis of hip fracture, stroke, or lower extremity joint replacement.

Principal findings: Although the effects of the payment systems on the use of post-acute care varied, most reduced the use of the site of care they directly affected and boosted the use of alternative sites of care. Payment system changes do not appear to have differentially affected the severely ill.

Conclusions: Payment system incentives play a significant role in determining where Medicare beneficiaries receive their post-acute care. Changing these incentives results in shifting of patients between post-acute sites.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement / rehabilitation
  • Female
  • Health Care Surveys
  • Health Services Accessibility / statistics & numerical data*
  • Hip Fractures / rehabilitation
  • Home Care Agencies / economics*
  • Home Care Agencies / statistics & numerical data
  • Humans
  • Male
  • Medicare
  • Models, Statistical
  • Prospective Payment System / statistics & numerical data*
  • Regression Analysis
  • Rehabilitation Centers / economics*
  • Rehabilitation Centers / statistics & numerical data
  • Skilled Nursing Facilities / economics*
  • Skilled Nursing Facilities / statistics & numerical data
  • Stroke Rehabilitation
  • United States