When the Medicare program introduced its prospective payment system for inpatient acute-care services in 1984, the hospital mantra became diversify, diversify, diversify.
Once the nearly exclusive domain of large national players like Beverly Enterprises in nursing home care and the Visiting Nurse Association in home care, the post-acute-care market became a crowded field as Medicare and Medicaid continued their lenient payment policies in those areas.
But federal budget-cutters are finally catching up:
* An interim prospective payment system for Medicare-certified home-care agencies kicked in Oct. 1, 1997. Medicare intends to move to a full-blown PPS for home care next year.
*n A prospective payment system for Medicare-certified skilled nursing facilities went into effect July 1, 1998.
* HCFA is working on implementing a federally mandated PPS for both inpatient rehabilitation care and outpatient ambulatory care for Medicare beneficiaries.
* HCFA is researching a PPS for psychiatric care.
In reaction, some of the traditional providers that claimed getting into post-acute care extended their "mission" are now getting out of it, saying they need to get "back to basics." And post-acute-care providers that were once on a buying binge are paring their services.
One of the most visible signs of the retrenchment was the decision in June by HealthSouth Corp. to split into two separate companies.
A series of large-scale acquisitions in the mid-1990s went a long way toward fulfilling the vision of HealthSouth Chairman and Chief Executive Officer Richard Scrushy to create the nation's most comprehensive post-acute-care company under one corporate umbrella. In a restructuring expected to be completed this fall, HealthSouth intends to divide into separate inpatient and outpatient companies.
With all the changes, you can't tell the players without a scorecard. This chapter of By the Numbers lists:
* The 20 largest nursing home chains. The largest is Beverly, with 64,100 beds. A distant second is Vencor, with 40,900 beds.
* The 20 largest home-care companies.
* The 20 largest assisted-living companies.
* The 25 largest inpatient rehabilitation hospitals. Six of the 25 are located in Massachusetts.
* Data about how the utilization of inpatient and outpatient psychiatric services already is changing in anticipation of a PPS for Medicare beneficiaries who need mental health services.