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November 26, 2003

The 1997 Balanced Budget Act and Home Services Among Medicare Patients

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(20):2661. doi:10.1001/jama.290.20.2661-a

In Reply: Drs Han and Remsburg point out that some patients in the 1998 NHHCS cohort received some of their care before implementation of the 1997 BBA. If anything, the inclusion of patients who received some of their care before the BBA in our 1998 (post-BBA) cohort would have biased our results toward finding no effect of the BBA. Thus, the true effect of the BBA on length of stay in home care may be even larger than we estimated.

We agree that our measures of functional status may have underestimated functional dependency, as the NHHCS collected information about home care agencies' assistance with ADL and IADL, but not assistance from other sources.1 We thank Han and Remsburg for clarifying that NHHCS data are obtained by personal interviews of home health agency staff rather than by telephone surveys.

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