ALTHOUGH MORE than 1,300 home health agencies have closed in the wake of the interim payment system, the General Accounting Office continues to maintain that home health access is not a problem. Preliminary findings of a new George Washington University study, however, paint a far different picture.

In order to survive tightened reimbursement under IPS, HHAs have had to change the case mix of their patients, the study reports. The IPS mandated a decrease in per-visit cost limits, a new per-beneficiary limit and elimination of coverage for venipuncture. The result: Some seriously ill patients have lost their Medicare services.

"The preliminary findings strongly suggest that agencies are responding to IPS incentives by avoiding the care of the sickest and frailest beneficiaries, while relatively healthy beneficiaries may be experiencing improved access to care," said Barbara Smith, senior researcher at the Center for Health Services Research and Policy at George Washington University, Washington, D.C. Some agencies are more weighted toward chronically ill patients, so they haven't been able to change their mix and have instead had to cut back drastically on their patient visits, she said.

The survey targeted five agencies in each of nine states, with a response rate between 70 and 80 percent, Smith said. She expects the final report to be released sometime this month.