United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2000-04-07 monographic deposited born digital 53 p. GA 1.13:HEHS-00-9 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-00-9 P0b002ee180397e6d f:he00009 DGPO 2010-08-12 2011-03-23 GAOREPORTS-HEHS-00-9 machine generated eng fdlp REPORT GAOREPORTS-HEHS-00-9 HEHS-00-9 Home health care services Health care cost control Health resources utilization Claims processing Health insurance Medical information systems Health care programs Internal controls Medicare Program Medicare Prospective Payment System HHS Home Health Care Services and Training Program Letter Report HEHS Pursuant to a legislative requirement, GAO reviewed the Health Care Financing Administration's (HCFA) research on a home health prospective payment system (PPS), focusing on: (1) the objectives, findings, and costs of the research and demonstration projects HCFA has funded that were related to the design of the PPS; and (2) how these projects contributed to the proposed PPS design and which design decisions were based on incomplete information.<p/>GAO noted that: (1) HCFA has sponsored a number of research and demonstration projects on payment design and home health care users and service delivery since 1987 at a cost of almost $27 million; (2) despite these important efforts, key features of a PPS were not evaluated in these projects, which limits the ability to evaluate the effects of certain payment policies on home health care service delivery and spending; (3) HCFA's major home health agencies (HHA) payment demonstration project provided evidence that HHAs would reduce their costs of providing home health visits when paid under a PPS model that tightly limited both their profits and their losses; (4) furthermore, the demonstration did not develop a case-mix adjustment method to alter payments for expected differences in resource use across groups of patients; (5) however, an ongoing research project has constructed an initial case-mix adjustment method for the PPS and will continue to refine this method as more data become available; (6) other HCFA-sponsored research projects have documented the variation in home health care service delivery; (7) these projects have demonstrated that methods for quality measurement and monitoring are not well developed, which will impair the ability to evaluate the effect of payment changes; (8) although HCFA's research and demonstration projects have proven useful in designing the PPS, information gaps remain; (9) these gaps mean that the PPS could cause unintended consequences for some beneficiaries, some HHAs, or the level of Medicare spending; (10) concerns remain about whether the case-mix adjustment method will adequately group patients with like resource needs and then appropriately adjust payments for beneficiaries in each group; (11) furthermore, how a patient is classified and how much the agency is paid are very dependent on whether, and how much, therapy services are provided; (12) without adequate design features, Medicare could overpay for unneeded services or underpay for required care, resulting in beneficiaries facing access problems or receiving poor quality of care; (13) although the change from cost-based payments to prospective payments is intended to help Medicare control its spending, how costs and service provision will change under the new system is unknown; and (14) therefore, HCFA will need to have sufficient resources to monitor service delivery across types of beneficiaries and across HHAs so that inadequate or medically inappropriate care can be identified. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-00-9/html/GAOREPORTS-HEHS-00-9.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-00-9/pdf/GAOREPORTS-HEHS-00-9.pdf GAO/HEHS-00-9 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-00-9 Letter Report GAO/HEHS-00-9; Medicare Home Health Care: Prospective Payment System Will; Home health care services Health care cost control Health resources utilization Claims processing Health insurance Medical information systems Health care programs Internal controls Medicare Program Medicare Prospective Payment System HHS Home Health Care Services and Training Program Public Law 105-277 Public Law 106-113