US nursing-home population composition in the PPS-era.

Area of Science:

• Health Services Research
• Gerontology
• Public Health Policy

Background:

• The prospective payment system (PPS) under the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 aimed to control hospital costs.
• Concerns were raised that PPS might lead to quicker and sicker Medicare patient discharges to nursing homes.
• This could potentially alter the demographic and health status composition of nursing home residents.

Purpose of the Study:

• To investigate whether the prospective payment system (PPS) influenced the composition of the US nursing home population.
• To compare nursing home residents admitted before and after the implementation of TEFRA's PPS.

Main Methods:

• Utilized baseline public use data from the 1987 National Medical Expenditure Survey-Institutional Population Component.
• Compared nursing home residents admitted in periods adjacent to the 1982 TEFRA legislation.
• Analyzed resident data for differences in reported deficits, hypothesizing increased deficits for those admitted under PPS.

Main Results:

• The study found no general change in the composition of the nursing home population attributable to the prospective payment system (PPS).
• Observed trends did not support the hypothesis that PPS admission led to a higher prevalence of deficits among nursing home residents.
• Potential effects of PPS may be limited to short-stay patients, with no clear impact observed on the long-stay population in this dataset.

Conclusions:

• The prospective payment system (PPS) implemented by TEFRA does not appear to have broadly changed the overall composition of nursing home residents.
• The hypothesis that PPS would lead to sicker patients being admitted to nursing homes was not supported by the data for the long-stay population.
• Further research may be needed to explore PPS effects on different patient subgroups, such as short-stay residents.