Medicare home health care patient case-mix before and after the Balanced Budget Act of 1997: effect on dual eligible beneficiaries.

The Balanced Budget Act (BBA) of 1997 changed the payment system for Medicare home health care (HHC) from cost-based to prospective reimbursement. We used Medical Expenditure Panel Survey data to assess the impact of the BBA on Medicare HHC patient case-mix measured by the Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS-HCC) model. There was a significant increase in Medicare HHC patient case-mix between the pre-BBA and Prospective Payment System (PPS) periods. The increase in the standardized-predicted risk score from the Interim Payment System period to PPS was nearly 4 times greater for the dual eligibles (Medicare-Medicaid) than for the Medicare-only population. This significantly greater rise in the HHC resources required by dual eligibles as compared to nonduals could be due to a shift in HHC payers from Medicare only to Medicaid rather than be an actual increase in case-mix per se.

The future role of nursing in health promotion.

Never before has health promotion been more important than it is today. Nurses in education, practice, and research settings can participate in the advancement of health promotion not only to the mainstream but to the forefront of nursing practice. Historically, nurse educators have taught patients how to manage illness; in the future, the focus must be on teaching people how to remain healthy. Nurses must have an evidence-based understanding of the significant effect that can be made through health promotion interventions and communicate this understanding to the public at large. As more people grow in their awareness of activities that lead to good health and become knowledgeable about their own health status and the health of their families, the overall health of the population will improve.