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Titre : | Impact of Outpatient Rehabilitation Medicare Reimbursement Caps on Utilization and Cost of Rehabilitation Care After Ischemic Stroke: Do Caps Contain Costs? (2015) |
Auteurs : | Annie N. Simpson ; Heather S. Bonilha ; Abby S. Kazley |
Type de document : | Article |
Dans : | Archives of Physical Medicine and Rehabilitation (2015/11, 2015) |
Article en page(s) : | pp. 19591965 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Accident vasculaire cérébral (AVC) ; Rééducation et réadaptation |
Mots-clés: | Costs and cost analysis ; Coûts et analyse des coûts ; Medicare ; Medicare (USA) ; Stroke |
Résumé : |
Objective To estimate the proportion of patients with ischemic stroke who fall within and above the total outpatient rehabilitation caps before and after the Balanced Budget Act of 1997 took effect; and to estimate the cost of poststroke outpatient rehabilitation cost and resource utilization in these patients before and after the implementation of the caps. Design Retrospective cohort study. Setting Medicare reimbursement system. Participants Medicare beneficiaries from the state of South Carolina: the 1997 stroke cohort sample (N=2667) and the 2004 stroke cohort sample (N=2679). Interventions Not applicable. Main Outcome Measures Proportion of beneficiaries with bills within and above the cap before and after the cap was enacted, and total estimated 1-year rehabilitation Medicare payments before and after the cap. Results The proportion of patients with stroke exceeding the cap in 2004 after the Balanced Budget Act of 1997 was enacted was significantly lower (5.8%) than those in 1997 (9.5%) had there been a cap at that time (P=.004). However, when the proportion of individuals exceeding the cap among both the outpatient provider and facility files was examined, there was a greater proportion of patients with stroke in 2004 (64.6%) than in 1997 (31.9%) who exceeded the cap (P<.0001 the estimated average medicare payments for rehabilitation services when examining only part b outpatient provider bills did not differ between cohorts and in fact decreased slightly from to however costs using all available greatly increased> Conclusions These findings suggest that billing practices may have changed after outpatient rehabilitation services caps were enacted by the Balanced Budget Act of 1997. Rehabilitation services billing may have shifted from Part B provider bills to being more frequently included in facility charges. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S0003999315005912 |