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The 1997 Balanced Budget Act and Home Services Among Medicare Patients
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To the Editor: Dr Murkofsky and colleagues1 found that, after passage of the 1997 Balanced Budget Act (BBA), length of stay in home care decreased among Medicare patients, particularly among those receiving care from for-profit home health agencies (HHAs). The authors obtained data for their study from the National Home and Hospice Care Surveys (NHHCS). Several aspects of the NHHCS, however, may limit the authors' conclusions.
First, the discharges sampled from the 1998 NHHCS occurred between October 1997 and September 1998. The BBA became effective on October 1, 1997. In the 1998 NHHCS, approximately 18% of Medicare HHA patients had been admitted before October 1, 1997. These patients would have used most of their HHA services during the pre-BBA period with some patients being discharged shortly after the BBA was implemented. Overlapping observation periods among some patients may confound the assessment of the BBA's impact.
Second, the information collected by . . . [Full Text of this Article]
Beth Han, MD, PhD, MPH;
Robin E. Remsburg, PhD, APRN, BC
National Center for Health Statistics
Hyattsville, Md
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