Outcome and utilization differences for older persons with stroke in HMO and fee-for service systems
Article Abstract:
Outcome and utilization differences for older persons with stroke in HMO and fee-for service (FFS) systems have been compared in an inception cohort of 429 patients receiving rehabilitation and stratified by payer. Six HMOs and five FFS systems with large Medicare populations in different parts of the US were the setting It appears that short-term functional outcomes and eventual community residence rates are poorer for Medicare HMO patients with stroke than for stroke patients receiving FFS care, which is consistent with the lower intensity of rehab in nursing homes vs rehab hospitals and less specialty physician care.
Publication Name: Journal of the American Geriatrics Society
Subject: Seniors
ISSN: 0002-8614
Year: 2000
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The quality of managed care is strained
Article Abstract:
The study into HMO vs fee-for-service care of those who have suffered a stroke maybe affected by identifying cases at time of admission to a rehabilitation unit or a nursing home, thereby eliminating those who went home without or without home health care. Investigation shows that 31% of FFS stroke cases of a given sample were discharged home with no post-acute care (PAC) and that 21% had home health care. No comparable data are available for HMO discharges. Before HMOs can be expected to change service the nature of capitated payment must be changed to address risk adjustments. Medicare+Choice changes do not seem to help. HMO care is less cost effective than it had been thought to be.
Publication Name: Journal of the American Geriatrics Society
Subject: Seniors
ISSN: 0002-8614
Year: 2000
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Outcomes of older persons receiving rehabilitation for medical and surgical conditions compared with hip fracture and stroke
Article Abstract:
A prospective cohort study has been carried out in posthospital rehabilitation Medicare patients older than 64. Medical-surgical patients numbering 290 were compared with 429 stroke patients and 336 hip fracture patients. Findings show that medical/surgical patients represent a unique rehabilitation population with more premorbid functional disability, less acute decline, and greater mortality vs those with traditional rehabilitation diagnoses.
Publication Name: Journal of the American Geriatrics Society
Subject: Seniors
ISSN: 0002-8614
Year: 2000
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