Trend Watch: The Impact of the BBA and the BBRA
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Quantify the BBA and BBRA
impacts on the secular growth in the size of hospital residency programs through changes in actual, allowed, and capped residents.
To reduce the negative impact the BBA has had and to take advantage of the provisions in the BBRA
, small rural hospitals should expand outpatient services, embrace telemedicine and telehealth initiatives, and actively seek alternative funding from foundations and other sources.
was introduced to try and offset some of these reductions but according to the American Hospital Association, hasn't gone far enough.
Despite numerous requests by many different pundits, HCFA declined to expand the list of items excluded from PPS consolidated billing, beyond those expansions already allowed by the BBRA
55 PP in 2002 (net of BBRA
and Benefits Improvement and Protection Act [BIPA] relieves).
The BBA policy variables show that residents diagnosed during an FY starting after July 1, 1998 were more likely to be diagnosed at death, but neither the BBA phase-in nor the BBRA
variable was statistically significant when all the three variables are included in the model.
mandate was the stimulus for three recent studies: CMS contracted with RTI International, to develop measures of patient-specific per diem cost that improve on previously available cost measures using a patient sample from 40 psychiatric facilities (Cromwell et al.
Clearly, if rural hospitals can implement each of the recommendations they should be able to survive the changes wrought by the BBA and the BBRA
, all other matters being equal.
Provisions of the BBRA
and BIPA that expired in the fourth quarter of 2002 reduced Medicare revenues in the Company's nursing centers by approximately $28 million for the first six months of 2003 compared to the same period a year ago.
2) Has the implementation of the 1999 BBRA
or the 2000 BIPA attenuated BBA impacts?