Washington The General Accounting Office found little evidence that the interim payment system and resulting agency closures have hurt access to Medicare's home health benefit, according to a report released May 26.

In Medicare Home Health Agencies: Closures Continue with Little Evidence Beneficiary Access Is Impaired, GAO said that although 14 percent of home health agencies closed between October 1, 1997, and January 1, 1999, beneficiaries are still served by more than 9,000 HHAs-about the same number as in 1996.

GAO also pointed out that 40 percent of the closures were concentrated in three states that had experienced "considerable growth" in the number of HHAs and had utilization rates "well above the national average." In addition, a majority of the closures occurred in urban areas that still have a large number of agencies to provide services, the report stated.

Overall, home health utilization in the first three months of 1998 had dropped since 1996, but it was about the same as 1994-the year that serves as the base for IPS limits.

"Our interviews in 34 primarily rural counties with substantial closures indicate that beneficiaries continue to have access to services," the report said. "However, those interviews also suggest that as HHAs change their operations in response to the IPS, beneficiaries who are likely to be costlier than average may have increased difficulty obtaining home health care."

The study's results are based on data from the Health Care Financing Administration about the number and characteristics of Medicare-certified HHAs through January 1, 1999, and beneficiary utilization during the first quarter of 1998, the most recent data available, GAO said. It also interviewed 130 people "with an interest or knowledge of HHA issues," such as HHA managers, hospital discharge planners and advocacy groups.