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J Am Geriatr Soc. 2011 Jan;59(1):3-9. doi: 10.1111/j.1532-5415.2010.03230.x. Epub 2011 Jan 3.

The effect of state policies on nursing home resident outcomes.

Author information

1
Center for Gerontology and Health Care Research and Department of Community Health, Alpert Medical School, Brown University, Providence, Rhode Island, USA. vincent_mor@brown.edu

Abstract

OBJECTIVES:

To test the effect of changes in Medicaid reimbursement on clinical outcomes of long-stay nursing home (NH) residents.

DESIGN:

Longitudinal, retrospective study of NHs, merging aggregated resident-level quality measures with facility characteristics and state policy survey data.

SETTING:

All free-standing NHs in urban counties with at least 20 long-stay residents per quarter (length of stay > 90 days) in the continental United States between 1999 and 2005.

PARTICIPANTS:

Long-stay NH residents

INTERVENTIONS:

Annual state Medicaid average per diem reimbursement and the presence of case-mix reimbursement in each year.

MEASUREMENTS:

Quarterly facility-aggregated, risk-adjusted quality-of-care measures surpassing a threshold for functional (activity of daily living) decline, physical restraint use, pressure ulcer incidence or worsening, and persistent pain.

RESULTS:

All outcomes showed an improvement trend over the study period, particularly physical restraint use. Facility fixed-effect regressions revealed that a $10 increase in Medicaid payment increased the likelihood of a NH meeting quality thresholds by 9% for functional decline, 5% for pain control, and 2% for pressure ulcers but not reduced use of physical restraints. Facilities in states that increased Medicaid payment most showed the greatest improvement in outcomes. The introduction of case-mix reimbursement was unrelated to quality improvement.

CONCLUSION:

Improvements in the clinical quality of NH care have been achieved, particularly where Medicaid payment has increased, generally from a lower baseline. Although this is a positive finding, challenges to implementing efficient reimbursement policies remain.

PMID:
21198463
PMCID:
PMC3731756
DOI:
10.1111/j.1532-5415.2010.03230.x
[Indexed for MEDLINE]
Free PMC Article

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