Early indications are that the Medicare home health prospective payment system (PPS) has controlled Medicare home health expenditures. However, studies indicate many unresolved questions about whether PPS improves patient quality of care and is cost-effective. The article reviews effective home-based palliative care interventions and presents the views of seven home health care nurses regarding the impact of Medicare requirements on their care decisions for one chronic disease population—Alzheimer's disease. The article asserts the current failure to simultaneously address the cost and quality-of-life issues of home health Alzheimer's patients is analogous to the end-of-life care situation Medicare confronted in the 1970s prior to the Medicare hospice demonstration program that preceded the Hospice Medicare Benefit. The article asserts that a similar demonstration is appropriate to determine how PPS might better meet patient quality-of-life needs and the government's need to reduce costs.
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