Changes in Follow-Up Care for Medicare Surgical Patients Under the Prospective Payment System

by Gerald Kominski, Andrea K. Biddle-Zehnder

Download

Download eBook for Free

FormatFile SizeNotes
PDF file 2.3 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.

Purchase

Purchase Print Copy

 FormatList Price Price
Add to Cart Paperback68 pages $25.00 $20.00 20% Web Discount

This study examined changes in the number and site of source of follow-up visits provided to Medicare surgical patients between 1984 and 1986. Among the 21 surgical procedures studied, follow-up visits declined by 5.2 percent, after adjusting for case mix. Despite the physician fee freeze during most of the study period, total allowed charges increased by 8.1 percent, indicating that the average intensity of visits increased by 14.0 percent. Inpatient visits declined by 6.7 percent, while outpatient visits increased by 3.9 percent. Thus, while some substitution of outpatient for inpatient visits occurred, PPS-related reductions in inpatient length of stay were associated with reductions in both the total visits and total allowed charges. Holding other factors constant, the 9.5-percent overall reduction in length of stay produced a 6.4-percent reduction in total allowed charges. We conclude that PPS had a significant effect in reducing the growth of Medicare expenditures for physician visits. The reduction in submitted claims for inpatient follow-up visits and the absence of a strong substitution effect suggest that some inpatient visits may not have been necessary.

This report is part of the RAND Corporation Report series. The report was a product of the RAND Corporation from 1948 to 1993 that represented the principal publication documenting and transmitting RAND's major research findings and final research.

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit www.rand.org/pubs/permissions.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.