Buchanan J L, Rumpel J D, Hoenig H
Health Sciences Program, RAND Corporation, Santa Monica, CA, USA.
Arch Phys Med Rehabil. 1996 Apr;77(4):320-8. doi: 10.1016/s0003-9993(96)90078-7.
This study compares Medicare program charges through time for outpatient rehabilitation services across different types of institutional providers.
Observational study of Medicare Part B claims. The analytic methods include a decomposition analysis and analysis of variance via regression.
Data come from six different institutional providers types: community hospital outpatient departments, rehabilitation hospital outpatient departments, skilled nursing facilities, independent rehabilitation agencies, comprehensive outpatient rehabilitation facilities, and home health agencies.
Five percent random sample of Medicare beneficiaries who used any institutionally based Part B physical, occupational, or speech therapy during the calendar years 1987 to 1990.
Charges for Medicare Part B rehabilitation therapies (physical and occupational therapy, speech pathology).
Charges for rehabilitation services grew more than 86% during this period across all provider types. Both the likelihood of using rehabilitation services and the average annual charges per patient grew rapidly. We found large differences in average annual per person charges and in the growth in charges across the six institutional provider types. Analyses that controlled for patient demographic characteristics and diagnoses across five provider types did not explain observed differences. Hospital outpatient departments were consistently the least costly type of institutional provider and independent rehabilitation agencies the most expensive. Diagnostic data were not available for home health agency claims, so these were omitted from the multivariate analysis of annual charges.
The large increases in charges cannot be explained by increases in the Medicare eligible population, aging, or inflation. The level and differential in growth is highest among new provider types and those dominated by proprietary ownership. These observations suggest that therapy services are profitable and that provider incentives may be an important component in overall growth.
本研究比较了不同类型机构提供者在不同时间对门诊康复服务的医疗保险计划收费情况。
对医疗保险B部分索赔的观察性研究。分析方法包括分解分析和通过回归进行的方差分析。
数据来自六种不同类型的机构提供者：社区医院门诊部、康复医院门诊部、熟练护理设施、独立康复机构、综合门诊康复设施和家庭健康机构。
1987年至1990年期间使用任何基于机构的B部分物理、职业或言语治疗的医疗保险受益人的5%随机样本。
医疗保险B部分康复治疗（物理治疗和职业治疗、言语病理学）的收费。
在此期间，所有提供者类型的康复服务收费增长超过86%。使用康复服务的可能性和每位患者的年均收费均迅速增长。我们发现六种机构提供者类型在人均年均收费以及收费增长方面存在巨大差异。对五种提供者类型的患者人口统计学特征和诊断进行控制的分析并不能解释观察到的差异。医院门诊部一直是成本最低的机构提供者类型，而独立康复机构则是最昂贵的。家庭健康机构索赔没有诊断数据，因此在年度收费的多变量分析中省略了这些数据。
收费的大幅增加不能用符合医疗保险资格的人口增加、老龄化或通货膨胀来解释。新提供者类型以及那些以私有制为主导的提供者类型的收费增长水平和差异最大。这些观察结果表明治疗服务有利可图，提供者激励措施可能是总体增长的一个重要因素。
