Prospective payment: systemic effects on the provision of community care for the elderly

The financial incentives of Medicare's Prospective Payment System are encouraging hospitals to discharge patients sooner and at a lower functional status. This discussion analyzes the possible impact of the subacute patient on the community system of care. Three broad areas of potential impact are examined: the systemic changes in the community system of care stimulated by vertical integration and the influx of proprietaries into community service delivery; structural changes which may be experienced by community service agencies in meeting the demands of increased volume and increased acuity; the impact on the family and the informal system of care delivery as it responds to the increased demands of caring for the subacute patient.