Curtiss F R
Am J Hosp Pharm. 1988 Aug;45(8):1682-90.
The current status of reimbursement for home health-care (HHC) products and services is described, and the influence of competition and consolidation on the HHC industry is discussed. Despite inadequate financing and reimbursement pressures, the demand for HHC services continues to grow. The degree of competition in the HHC industry is reflected in bundling of services (gathering payments for services into a single per-capita rate), prospective price negotiations, and competitive bidding. This competition within the home-care industry and pressure on operating margins have spawned a flurry of recent mergers, acquisitions, and corporate restructuring. HHC agencies and suppliers, particularly durable medical equipment suppliers, have been squeezed by inadequate Medicare cost-finding methods, low reimbursement rates, and a high number of denials of Medicare coverage. Three important recent federal measures revised definitions of Medicare coverage, established minimum and maximum payment periods for Medicare reimbursement, reduced payments for services and products covered under Medicare Parts A and B, resurrected prospective-pricing demonstration projects, reduced payments for durable medical equipment and home oxygen supplies, and expanded coverage of services for AIDS patients. State Medicaid program budgets are threatened by recurring administration proposals to cap federal matching payments and by the adoption of a competitive-bid approach to health-care contracting. To survive over the next few years, home health agencies and home-care suppliers will need to monitor operating costs even more closely and pay attention to the patient (payer) mix.
本文描述了家庭保健（HHC）产品和服务的报销现状，并讨论了竞争和合并对HHC行业的影响。尽管资金不足且报销压力较大，但对HHC服务的需求仍在持续增长。HHC行业的竞争程度体现在服务捆绑（将服务费用合并为单一的人均费率）、前瞻性价格谈判和竞争性投标中。家庭护理行业内部的这种竞争以及运营利润率的压力引发了近期一系列的合并、收购和公司重组。HHC机构和供应商，尤其是耐用医疗设备供应商，受到医疗保险成本核算方法不完善、报销率低以及大量医疗保险覆盖范围被拒的挤压。最近三项重要的联邦措施修订了医疗保险覆盖范围的定义，确定了医疗保险报销的最短和最长支付期限，降低了医疗保险A部分和B部分所涵盖服务和产品的支付费用，重启了前瞻性定价示范项目，降低了耐用医疗设备和家庭氧气供应的支付费用，并扩大了艾滋病患者服务的覆盖范围。州医疗补助计划预算受到反复出现的限制联邦配套支付的行政提案以及采用竞争性投标方式进行医疗保健合同签订的威胁。为了在未来几年生存下去，家庭保健机构和家庭护理供应商将需要更加密切地监控运营成本，并关注患者（付款人）组合。
