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August 7, 1987

The Impact of Medicare's Prospective Payment System on Wisconsin Nursing Homes-Reply

JAMA. 1987;258(5):613. doi:10.1001/jama.1987.03400050055022

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In Reply.—  I appreciate the opportunity to comment on the response by Sager et al to my editorial in the April 3, 1987, issue of JAMA.Dr Sager and his coauthors raise two issues regarding my review of their study. The first issue is the most serious and relates to the questions I raised about their finding that Wisconsin's institutionalized elderly Medicaid population experienced a 72% increase in the rate of hospitalization with the introduction of Medicare's hospital PPS. I wrote that a 72% increase for the institutionalized is so high as to suggest an artifact. Moreover, the findings in this study are not corroborated by any data from the Medicare program. This prompted me to question the utility of Medicaid claims data for analysis of Medicare hospitalizations. Because the subject is so important, I urged the authors to contact the Health Care Financing Administration to verify the figures presented in this study.