Patient shifting as a response to Medicare Prospective Payment

The Medicare Prospective Payment System (PPS) regulations provide hospitals with strong incentives to discharge patients sooner. It seems reasonable to assume that a large number of these discharged patients may require posthospital care in long-term care facilities (LTCFs). Such shifting of patients from hospitals to LTCFs would be evidenced by a sicker population of patients requiring more extensive and intensive treatments in the post-PPS period. The purpose of this study was to determine the extent to which patient shifting occurred after implementation of the PPS regulations. Data were collected from the medical records of 353 patients admitted to 10 LTCFs in Georgia both before and after the PPS was implemented. Comparisons of the two groups indicated no significant differences in LTCF admitting diagnoses, numbers of patients dying or being readmitted to the hospital within 30 days of LTCF admission, prognosis, or rehabilitative potential. The groups differed to a statistically significant extent on three treatment and health status variables: patients in the post-PPS group were more likely to be incontinent of bladder, to have nasogastric tubes, and to be on dietary supplements. These differences may suggest the beginning of a trend to shift heavier care patients into LTCFs. As a whole, however, the results of this study indicated limited shifting of patients from hospitals to LTCFs in Georgia during the first year after implementation of the PPS regulations.