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New entrants' practice patterns in Medicare home health care after the prospective payment system revision in 2008

机译：2008年预期付款系统修订后，新进入者在Medicare家庭保健中的实践模式

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Background: Medicare home health care spending increased under the prospective payment system (PPS) that was introduced specifically to control the rising spending. To explain this unexpected spending rise, we focused on new home health agencies that entered the market under the PPS. The high profit margins under the PPS attracted many new agencies to the market partially due to home health care's unique feature of low entry costs. We examined whether new entrants were more likely to adopt the practice patterns leading to higher profit margins than incumbent agencies that had been operating in the market before the PPS.Methods: Using 2008 to 2010 Medicare Home Health Claims and Provider of Services File, we estimated regressions of agencies' practice patterns controlling for agency and patient characteristics. Results: We found that new entrants were more likely than incumbents to adopt practice patterns leading to high profit margins. They were more likely to target the 14th and 20th therapy visit where marginal revenue is relatively greater than that of other number of visits. Under the payment system that compensates extra therapy visits but not for other types of visits, entrants were also more likely to provide therapy visits, but less likely to provide medical social service visits.
机译：背景：在专门为控制不断增长的支出而引入的预期付款系统（PPS）下，Medicare家庭医疗保健支出有所增加。为了解释这种意外的支出增长，我们重点介绍了根据PPS进入市场的新的家庭保健机构。 PPS的高利润率吸引了许多新机构进入市场，部分原因是家庭医疗保健的低进入成本这一独特特征。我们检查了新进入者是否比PPS之前在市场上运营的现有代理机构更可能采用导致较高利润率的实践模式。方法：我们使用2008年至2010年的Medicare家庭健康索赔和服务提供者档案进行估算机构对病人和代理人特征的控制方式的回归。结果：我们发现，新进入者比现有者更有可能采用导致高利润率的实践模式。他们更有可能针对第14和第20次就诊，其边际收益相对高于其他就诊次数。在补偿额外的治疗就诊但不补偿其他类型就诊的支付系统下，参与者也更可能提供治疗就诊，但不太可能提供医疗社会服务就诊。

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