Biomedical subjects

Frank W Porell

Publications and source records attributed to Frank W Porell.

8 recordsLinked to original sources

PubMed2006

Agency and market area factors affecting home health agency supply changes.

OBJECTIVE: To use the natural experiment created by the Medicare interim payment system (IPS) to study supply change behavior of home health agencies (HHAs) in local market areas. DATA SOURCES: One hundred percent Medicare home health claims for 1996 and 1999, linked with Medicare Provider of Service and Denominator files, and the Area Resource File. STUDY DESIGN: Medicare home health care (HHC) claims data were used to distinguish HHAs that changed the local market supply of Medicare HHC by their market exit or by significant expansion or contraction of their geographic service area between 1996 and 1999 from other HHAs. Multinomial logit models were estimated to analyze how characteristics of agencies and the market areas in which they served were associated with these different agency-level supply changes. PRINCIPAL FINDINGS: Changes in local HHA supply stemming from geographic service area expansions and contractions rivaled those owing to agency closures and market entries. Agencies at greater risk of closure and service area contraction tended to be smaller, newer, freestanding agencies, operating with more visit-intensive practice styles in markets with more competitor agencies. Except for having much less visit-intensive practice styles, similar attributes characterized agencies that increased local supply through service area expansion. CONCLUSIONS: Supply changes by HHAs largely reflected rational market responses by agencies to significant changes in financial incentives associated with the Medicare IPS. Recently certified agencies were among the most dynamic providers. Supply changes were more likely among agencies operating in more competitive market environments.

Catchment Area, Health↗

PubMed2006

Nursing home performance on select publicly reported quality indicators and resident risk of hospitalization: grappling with policy implications.

This study examines how resident risk of hospitalization varies in relation to facility performance on select quality indicators (QIs). Using a 15% sample, three years of Medicaid reimbursement data from over 525 nursing homes (NHs) were linked with four years of hospital claims data and facility-level data to investigate whether residents of NHs with worse (better) than expected performance on QIs experienced increased (decreased) risk of hospitalization. Logistic regression results indicate that variations in hospitalization risk among NH residents are explained in part by facility performance on QIs. Residents from NHs with more decubitus ulcers, with greater use of physical restraints, and with a higher than expected incidence of unexplained weight loss/gain experienced increased risk of hospitalization.

Aged↗

PubMed2005

Discretionary hospitalization of nursing home residents with and without Alzheimer's disease: a multilevel analysis.

UNLABELLED: This study analyzes facility variations in hospital admission rates of nursing home (NH) residents with and without Alzheimer's disease (AD) or related dementia with the aim of better understanding how facility-level contextual factors differentially affect hospitalization risks. METHOD: The sample population consists of 19,217 and 18,399 Medicaid residents with and without AD, respectively, from 546 NHs in Massachusetts between 1991 and 1993. Hospital use is measured as annual nonpsychiatric discretionary hospital admissions to short-term general hospitals. Multilevel estimation methods are used to obtain facility and market area parameter estimates. RESULTS: There was greater interfacility variation in discretionary hospital admission rates of AD residents than residents without AD, particularly among more vulnerable subgroups of AD residents. DISCUSSION: The findings underscore the importance of licensed nursing personnel in reducing discretionary hospitalizations among NH residents with AD.

Aged↗

PubMed2004

Hospital choice of rural Medicare beneficiaries: patient, hospital attributes, and the patient-physician relationship.

OBJECTIVE: To examine how patient and hospital attributes and the patient-physician relationship influence hospital choice of rural Medicare beneficiaries. DATA SOURCES: Medicare Current Beneficiary Survey (MCBS), Health Care Financing Administration (HCFA) Provider of Services (POS) file, American Hospital Association (AHA) Annual Survey, and Medicare Hospital Service Area (HSA) files for 1994 and 1995. STUDY DESIGN: The study sample consisted of 1,702 hospitalizations of rural Medicare beneficiaries. McFadden's conditional logit model was used to analyze hospital choices of rural Medicare beneficiaries. The model included independent variables to control for patients' and hospitals' attributes and the distance to hospital alternatives. PRINCIPAL FINDINGS: The empirical results show strong preferences of aged patients for closer hospitals and those of greater scale and service capacity. Patients with complex acute medical conditions and those with more resources were more likely to bypass their closest rural hospitals. Beneficiaries were more likely to bypass their closest rural hospital if they had no regular physician, had a shorter patient-physician tie, were dissatisfied with the availability of health care, and had a longer travel time to their physician's office. CONCLUSIONS: The significant influences of patients' socioeconomic, health, and functional status, their satisfaction with and access to primary care, and their strong preferences for certain hospital attributes should inform federal program initiatives about the likely impacts of policy changes on hospital bypassing behavior.

Aged↗

PubMed2003

Variations in hospitalization rates among nursing home residents: the role of facility and market attributes.

PURPOSE: This study examined the contribution of facility-level and area market-level attributes to variations in hospitalization rates among nursing home residents. DESIGN AND METHODS: Three years (1991-1994) of state quarterly Medicaid case-mix reimbursement data from 527 nursing homes (NH) in Massachusetts were linked with Medicare Provider Analysis and Review hospital claims and nursing facility attribute data to produce a longitudinal, analytical file containing 72,319 person-quarter observations. Logistic regression models were used to estimate the influence of facility-level and market-level factors on hospital use, after controlling for individual-level resident attributes, including: NH diagnoses, resident-level quality of care indicators, and diagnostic cost grouping classification from previous hospital stays. RESULTS: Multivariate findings suggest that resident heterogeneity alone does not account for the wide variations in hospitalization rates across nursing homes. Instead, facility characteristics such as profit status, nurse staffing patterns, NH size, chain affiliation, and percentage of Medicaid and Medicare reimbursed days significantly influence NH residents' risk of hospitalization. Broader area market factors also appear to contribute to variations in hospitalization rates. IMPLICATIONS: Variations in hospitalization rates may reflect underutilization, as well as overutilization. Continued efforts toward identifying medically necessary hospitalizations are needed.

Fees and Charges↗

PubMed2002

Regional differences in functional status among the aged.

This study investigated regional differences in functional status among aged Medicare beneficiaries in the United States, and the degree to which population risk factors and certain geographic/environmental attributes of communities accounted for the regional differences. Four years of the Medicare Current Beneficiary Survey (1992-1995) were pooled together yielding 37,150 person-year observations of functional status for a sample of aged Medicare beneficiaries residing in the community or nursing homes. Multinomial logit models, estimated on a four-category functional status scale, produced strong empirical evidence of substantial regional differences in the prevalence of functional independence, functional limitations, IADL limitations, and ADL limitations, that could not be attributed to regional population composition, socio-demographic factors, lifestyle characteristics, and chronic medical conditions. Although such population risk factors accounted for much of the regional variations in functional status among older men, the notably higher prevalence of IADL and ADL limitations among older women residing in the Deep South could not be similarly attributed to such risk factors. Rather, the empirical results suggest that a significant portion of the harmful effects associated with residence in the Deep South among older women may be attributed to a higher prevalence of residence in counties characterized by lower population density and/or higher poverty concentration.

Activities of Daily Living↗

PubMed2002

Home health and home care in Massachusetts after the Balanced Budget Act of 1997: implications of cost containment pressures for service authorizations.

This paper explores the response of the Massachusetts state-funded home care program for the elderly when its clients encountered barriers to the receipt of home health services because of HMO enrollment and the implementation of the Balanced Budget Act of 1997. Clients of three regional case management agencies serving the Massachusetts state home care program whose home care services were interrupted because of hospitalization between January 1 and April 30, 1999 and whose services were resumed after they returned home were studied. Detailed data are reported that show how the long-term personal assistance services provided through the state program were often complemented by temporary home health services after elders returned home. The multivariate analysis revealed that the authorization of state-funded personal care services was keyed to the status of home health aide services. After hospitalization, the presence of a home health aide reduced the likelihood of authorization of personal care. At final assessment, the situation was reversed, that is, the withdrawal of a home health aide increased the likelihood of authorization of personal care. The findings suggest that more restrictive Medicare reimbursement policies for home health services led to greater state expenditures for personal care services. In other words, less generous Medicare financing shifted a greater portion of the burden of financing home care to the state of Massachusetts. These findings raise important policy questions about the balance of responsibility between the federal government and states to provide financing of home care services for the elderly.

Aged↗

PubMedDate not supplied

Vulnerable populations at risk of potentially avoidable hospitalizations: the case of nursing home residents with Alzheimer's disease.

This study explores whether nursing home residents with Alzheimer's disease and related dementias (ADRD) are affected differently by facility-level risk factors of ambulatory care-sensitive (ACS) conditions, a measure of timely access to medical care. Three years of quarterly Medicaid reimbursement data from over 525 Massachusetts nursing homes were linked with four years of Medical Provider Analysis and Review hospital claims data and facility-level attribute data to investigate whether facility effects differed by resident ADRD status. The findings suggest that nursing home residents with ADRD are more likely to be hospitalized for certain ACS conditions, including gastroenteritis and kidney/ urinary tract infections. Availability of increased registered nurse staffing levels and on-site nurse practitioners appears to attenuate this risk. Although findings suggest that ACS hospitalization measures may represent a useful approach to monitoring nursing home care, additional effort is needed to understand the extent to which severity of illness and/or comorbidities affect the measurement of these hospitalizations.

Accidents↗