We would like to thank Dr Onder and his colleagues for their interest in our article. We are especially gratified that our work1 has prompted more investigation into the important issues that both of our reports explore. Similar to what we observed in Connecticut, Onder et al found that, in Italy, the mean hospital length of stay for elderly patients with pneumonia declined during the 1990s, both before and after the institution of a PPS. However, in marked contrast to our results, they found that the percentage of patients discharged to nursing facilities actually declined from 9.1% to 8.4% during the study period.
Metersky ML, Meehan TP. Prospective Payment System and Hospitalization for Pneumonia in Italy—Reply. Arch Intern Med. 2001;161(15):1918-1919. doi: