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Prospective payment. An idea whose time has come.

B R Lorenz, A B Meeker

    Caring : National Association for Home Care Magazine
    |June 7, 1992
    PubMed
    Summary
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    The home care industry lacks prospective payment rates, unlike Medicaid and hospice. This presents an opportunity for the industry to develop and propose new payment models.

    Area of Science:

    • Healthcare economics
    • Health services research
    • Home healthcare management

    Background:

    • Existing healthcare reimbursement models include Medicaid per-visit rates and hospice daily/hourly rates.
    • These models often feature patient limits, influencing financial sustainability.
    • A notable gap exists in the absence of comprehensive prospective payment rates specifically for home care services.

    Purpose of the Study:

    • To identify the gap in prospective payment rate development for the home care industry.
    • To explore the potential for industry input in creating new reimbursement structures.
    • To analyze the implications of the lack of established prospective rates on home care providers.

    Main Methods:

    • Comparative analysis of existing reimbursement structures (Medicaid, hospice).

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  • Identification of the absence of prospective rate models in home care.
  • Qualitative assessment of the potential for industry-led development of new rates.
  • Main Results:

    • Home care currently lacks the extensive prospective rate development seen in other sectors.
    • The existing rate structures for Medicaid and hospice offer precedents but are not directly applicable.
    • A significant opportunity exists for the home care industry to influence future payment models.

    Conclusions:

    • The absence of established home care prospective rates represents a critical gap in healthcare reimbursement.
    • Industry stakeholders are uniquely positioned to provide valuable input for developing innovative and sustainable payment models.
    • Addressing this gap could enhance financial stability and service delivery within the home care sector.