Review on Medicare and medicaid


Medicare & Medicaid Article Review


1. What changes were made in the Balance Budget act of 1997 that effected therapy reimbursement?
2. Why do you think there has been an increase in post acute care expenditures?
3. What did you take away from this article?
4. Critical appraisal of the article or resource attached, and a brief statement of application to occupational therapy practice.


Question 1:
In the Balanced Budget act of 1997, the changes that were made are:
Reduction in spending- changes were made in the amounts of money that were being spent
on the Patient Protection and Affordable Care. The time span which is known as the Length
of Stay has reduced to a consideration for the inpatient's rehabilitation. Such changes in
spending affected the therapy reimbursement.
Reduction in Home health care services- the Balanced Budget act of 1997, the usage of the
health services in the home was reduced (McCall et al. 2003, p.277). The numbers of people
residing in the skilled nursing facilities who receive a high rehabilitation have reduced.
Moreover, the Rehabilitation and the health care services are considered to be a part of the
vital coverage in PAC.
Increase in insurance cover- After the Balanced budget act of 1997, the insurance coverage
of the patients has increased and the quality of life that they lived has improved. This was due
to certain changes in the cost of the Medicare spending. After the Balanced budget act, the
amount of spending was reduced and changes were made in the technique of the
rehabilitation services resulting in a cost-effective treatment (Newhouse, 2004, p.107).
Question 2:
There has been an increase in the post-acute care expenditures because:
Neglecting the situation- In various acute care hospitals the doctor's do not give much
attention to post care. The patients are discharged from a post-acute care service where there
is no coordination (Chan, 2007). This makes the situation tough and patients undergo a
serious situation.
Reduction in the utilisation of home health care services- During the post-stage of the
prospective payment system it was seen that the home use of the home-based health care
services have decreased which had led to the decrease in the number of residents who resided
in the nursing services provided by skilled people who got a good therapy services.
Largely availed- Data shows that the Post-acute care expenditures have increased from 26.6
billion dollars to 63.5 billion. This is because there are many people who avail the post-acute
care services (McCall et al. 2003, p.277). A large population having access to the service has
led to the increase in the cost of providing the Post-acute service.

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Question 3:
The study of the article gives brief information about the factors regarding Occupational
therapy and Physical therapy in Post-acute rehabilitation systems. The most available form
of the outpatient therapy services comprises the outpatient rehabilitation. This article states
about the effects and the outcomes of the balanced budget in 1997. Before the Balanced
budget, the LOS or Length of Stay was increasing in context of the rehabilitation for
inpatients. The balanced budget of 1997 has made certain changes in the therapy
reimbursement. After the balanced budget, the Length of stay has decreased for inpatient
rehabilitation (Medicare Payment Advisory Commission, 2012). The use of the home health
services has decreased. The expenses that are related to the Post-acute care had faced an
increase because the Post-acute care services are found in many parts and a large amount of
population avails this services. Moreover, the proportions of the people or the residents
residing in the skilled nursing facilities who receive a huge amount of rehabilitation have
gone down. Besides, the Patient Protection and the Affordable care act was introduced in
March 2010 which had increased the amount of insurance coverage for the patients and led to
the decrease in the amount of money for the Medicare spending (Fasoli, Glickman, 2010,
p.288). The act increased the insurance cover and would instigate the aspect of rehabilitation
so that the services are given to various persons who are insured. Such aspects have been
taken away from this article and incorporated in the analysis.
Question 4:
The factors regarding the utilisation of OT and PT services in rehabilitation system is studied
by the article. Out of all the most common Post-acute care rehabilitation system is the
outpatient rehabilitation (McCall et al. 2003, p.277). The article describes the use of the
Occupational therapy and the Physical therapy in various parts of Post-acute care which is a
type of rehabilitation system. It defines the changes that have been introduced in the
rehabilitation system after the Balanced Budget of 1997 along with the causes for the increase
in the Post-acute care. Beneficiaries who have received various services from rehabilitation
can also utilise the therapy services from some other rehabilitation process but quantify the
processor services received by each and every medical beneficiary is not easy (Medicare
Payment Advisory Commission, 2012). The reason is that Medicare payment system is
different in various systems. The article studies the Medicare reimbursement policies but the
study is not fully accurate because the time period is restricted to the HRS linked claims.

Reference list

Chan L. (2007). The state-of-the-science: Challenges in designing post-acute care payment
policy. Archives of Physical Medicine and Rehabilitation 88:1522–1525.
Fasoli DR, Glickman ME, Eisen SV. (2010). Predisposing characteristics, enabling resources
and need as predictors of utilization and clinical outcomes for veterans receiving mental
health services. Medical Care 48:288–295.
McCall, N., Korb, J., Petersons, A., & Moore, S. (2003). Reforming Medicare payment: early
effects of the 1997 Balanced Budget Act on post-acute care. The Milbank Quarterly, 81(2),
Medicare Payment Advisory Commission (MedPAC). (2012). Post-acute care Databook:
Healthcare spending and the Medicare program. Washington, DC. p. 118. Retrieved from
Newhouse, J. P. (2004). Consumer-directed health plans and the RAND Health Insurance
Experiment. Health Affairs, 23(6), 107-113.

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