Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
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
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.
Murkofsky RL, Phillips RS, McCarthy EP, Davis RB, Hamel MB. The 1997 Balanced Budget Act and Home Services Among Medicare Patients. JAMA. 2003;290(20):2661. doi:10.1001/jama.290.20.2661-a