Evaluating the Effects of Medicare Prospective Payment on Post-Hospital Care

GAO discussed the effects of implementing a prospective payment system (PPS) for post-hospital care in the Medicare program, focusing on: (1) patients' condition when they are discharged from hospitals; (2) use of, expenditures for, and access to post-hospital care services; (3) the quality of care delivered by post-hospital services; and (4) the Health Care Financing Administration's (HCFA) use of information about PPS-related issues. GAO noted that there are three types of information that can be developed pertaining to post-hospital care, including: (1) descriptive information, which pertains to current statistics; (2) information pertaining to changes over longer periods of time; and (3) attributive information, which can address the question of whether changes in post-hospital care have been caused by PPS or by other factors. GAO also noted that HCFA will produce: (1) only limited data on patients' condition at hospital discharge; (2) adequate change-over-time data on the use of and expenditures for post-hospital services, but no attributive data; (3) no data on patients' access to post-hospital services; and (4) very little data on the quality of post-hospital care. In addition, GAO believes that HCFA should increase its development of attributive information for a wide range of PPS-related issues in order to provide a basis for evaluating the overall effectiveness of PPS.