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).
For a typical SNF, the effects of the BBRA
and BIPA were more than overshadowed by the shift in the BBA from cost reimbursement to prospective payment based on national rates.
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.
Most evident is the need to develop a per diem system to respond to the BBRA
In August 1999, the two lawmakers had urged an upward adjustment as part of another bill that included the BBRA
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.