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Concordance between planned and approved visits during initial home care
L G Branch1, H B Goldberg, V A Cheh
1Boston University School of Medicine.
Health Care Financing Review
|March 4, 1992
Summary
Medicare home health case managers often overestimate required services. Planned home care visits averaged 24.76, but only 15.95 were approved, highlighting a significant gap in service estimation.
Area of Science:
- Healthcare Management
- Gerontology
- Health Services Research
Background:
- Medicare home health agencies rely on initial assessments for service planning.
- Accurate estimation of client needs is crucial for resource allocation and effective care delivery.
Purpose of the Study:
- To evaluate the accuracy of initial service estimations by Medicare home health intake case managers.
- To compare planned versus approved home care services within the first 60 days of care.
Main Methods:
- Systematic examination of service data for 2,431 Medicare home health clients from 1986.
- Analysis of concordance between planned and approved service types and amounts.
Main Results:
- The mean number of planned visits was 24.76, while the mean approved visits were 15.95.
- Approved visits constituted an average of 64.4% of planned visits.
- Significant discrepancies were observed between estimated and actual reimbursed home health services.
Conclusions:
- Initial service estimations by Medicare home health case managers may be inflated.
- Further research is needed to refine intake assessment protocols for improved accuracy in home care planning.
- Understanding this gap is vital for optimizing Medicare home health resource utilization and patient care.