The effect of integration of hospitals and post-acute care providers on Medicare payment and patient outcomes.

In this paper we examine empirically the effect of integration on Medicare payment and rehospitalization. We use 2005-2013 data on Medicare beneficiaries receiving post-acute care (PAC) in the U.S. to examine integration between hospitals and the two most common post-acute care settings: skilled nursing facilities (SNFs) and home health agencies (HHA), using two measures of integration-formal vertical integration and informal integration representing preferential relationships between providers without formal relationships. Our identification strategy is twofold. First, we use longitudinal models with a fixed effect for each hospital-PAC pair in a market to test how changes in integration impact patient outcomes. Second, we use an instrumental variable approach to account for patient selection into integrated providers. We find that vertical integration between hospitals and SNFs increases Medicare payments and reduces rehospitalization rates. However, vertical integration between hospitals and HHAs has little effect, nor does informal integration between hospitals and either PAC setting.

Role of hospice and home care in a reformed care delivery system: ACOs, bundling, transitions in care, and more.

The way we deliver health care is changing fast and going in the direction of home care and hospice. This timely program addressed the threshold question of how your organization should play a part in a new arena that includes accountable care organizations, bundling of post-acute care, and integrated transitions in care. Should you be a partner with other health care sectors, assuming some of the financial risk for the success or failure of the endeavor? Should you choose instead to be an active participant or possibly a vendor to an integrated health delivery model? Join our panel as they discussed how to determine your role and gauge the community of health in which you function.

Financial success under PPS: how to beat the odds.

Whether you are a publicly held company or a small mom and pop agency, you have to maximize both efficiency and productivity while maintaining patient satisfaction and staff morale. In the new world of home care, this is a tall order. In this first installment of a two part series, the author reviews the dimensions of financial success, issues of length of stay and episode of care, resource utilization planning, and reducing overhead. The second part will cover overall productivity, clinical productivity, and management strategies to synergize financial success under the prospective payment system.

Assessing the strategy-performance paradigm: implications for organizational adaptation in discontinuous environments for home health care providers.

Home health care agencies are on the brink of experiencing prospective payment systems which will prove to be a major environmental shift. What will be the best strategy to offset the effects of prospective payment systems? Longitudinal studies of hospitals facing similar pressures may offer the best solution. This paper offers an attempt to address whether proactive or low cost strategies will provide home health agencies with higher firm performance after prospective payment systems.