The effect of state medicaid case-mix payment on nursing home resident acuity

Health Services Research

Volumn 41, Issue 4 I, 2006, Pages 1317-1336

  Feng, Zhanlian ^a   Grabowski, David C ^b   Intrator, Orna ^a   Mor, Vincent ^a  

^a BROWN UNIVERSITY   (United States)

^b HARVARD MEDICAL SCHOOL   (United States)

Author keywords

Access to care; Acuity; Case mix payment; Nursing homes

Indexed keywords

ARTICLE; DAILY LIFE ACTIVITY; DATA ANALYSIS; HEALTH CARE; HEALTH CARE ACCESS; HEALTH CARE COST; HEALTH CARE POLICY; HEALTH CARE UTILIZATION; HUMAN; INFORMATION PROCESSING; LONGITUDINAL STUDY; MEDICAID; NURSING HOME; NURSING HOME PATIENT; TIME SERIES ANALYSIS; UNITED STATES;

DIAGNOSIS-RELATED GROUPS; GERIATRIC NURSING; HEALTH CARE SURVEYS; HEALTH SERVICES ACCESSIBILITY; HUMANS; LONGITUDINAL STUDIES; MEDICAID; NURSING HOMES; REIMBURSEMENT MECHANISMS; UNITED STATES;

EID: 33746361165     PISSN: 00179124     EISSN: 14756773     Source Type: Journal    
DOI: 10.1111/j.1475-6773.2006.00545.x     Document Type: Article

References (60)

1. Arling, G., and B. Daneman. 2002. "Nursing Home Case-Mix Reimbursement in Mississippi and South Dakota." Health Services Research 37 (2): 377-95.
2. Bishop, C. E. 1999. "Where Are the Missing Elders? The Decline in Nursing Home Use, 1985 and 1995." Health Affairs (Millwood) 18 (4): 146-55.
3. Burwell, B., K. Sredl, and S. Eiken. 2005. "Medicaid Long Term Care Expenditures in FY 2004" [accessed March 20, 2006] Medstat. Available at http://www. hcbs.org/moreInfo.php/topic/207/sby/Author/lim/ALL/doc/1260/ Medicaid_ Long_Term_Care_Expenditures_in_FY_2004
4. Butler, P. A., and R. E. Schlenker. 1989. "Case-Mix Reimbursement for Nursing Homes: Objectives and Achievements." Milbank Quarterly 67 (1): 103-36.
5. Carter, G. M., J. P. Newhouse, and D. A. Relles. 1990. "How Much Change in the Case Mix Index Is DRG Creep?" Journal of Health Economics 9 (4): 411-28.
6. Centers for Medicare and Medicaid Services. 2003. "Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities-Update; Proposed Rule." Federal Register 68 (95): 26757-83.
7. Chulis, G. S. 1991. "Assessing Medicare's Prospective Payment System for Hospitals." Medical Care Research and Review 48 (2): 167-206.
8. Cohen, J. W., and L. C. Dubay. 1990. "The Effects of Medicaid Reimbursement Method and Ownership on Nursing Home Costs, Case Mix, and Staffing." Inquiry 27 (2): 183-200.
9. Cowles, C. M. 2002. Nursing Home Statistical Yearbook (2002). Montgomery Village, MD: Cowles Research Group.
10. Dugan, J. K. 1997. "Federal Government Expands Compliance Initiatives." Healthcare Financial Management 51 (9): 54-8.
11. Ettner, S. L. 1993. "Do Elderly Medicaid Patients Experience Reduced Access to Nursing Home Care?" Journal of Health Economics 12 (3): 259-80.
12. Feder, J., and W. Scanlon. 1980. "Regulating the Bed Supply in Nursing Homes." Milbank Quarterly 58 (1): 54-88.
13. _. 1989. "Case-Mix Payment for Nursing Home Care: Lessons from Maryland." Journal of Health Politics, Policy, and Law 14 (3): 523-47.
14. Friedman, B. 1982. "Economic Aspects of the Rationing of Nursing Home Beds." Journal of Human Resources 17 (1): 59-71.
15. Fries, B. E. 1990. "Comparing Case-Mix Systems for Nursing Home Payment." Health Care Financing Review 11 (4): 103-19.
16. Fries, B. E., D. P. Schneider, W. J. Foley, M. Gavazzi, R. Burke, and E. Cornelius. 1994. "Refining a Case-Mix Measure for Nursing Homes: Resource Utilization Groups (RUG-III)." Medical Care 32 (7): 668-85.
17. General Accounting Office. 2001. Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors. Washington, DC: General Accounting Office.
18. Gibson, M. J., S. R. Gregory, A. N. Houser, and W. Fox-Grade. 2004. Across the States: Profiles of Long-Term Care, 6th Edition. Washington, DC: AARP Public Policy Institute.
19. Grabowski, D. C. 2002. "The Economic Implications of Case-Mix Medicaid Reimbursement for Nursing Home Care." Inquiry 39 (3): 258-78.
20. Grabowski, D. C., J. J. Angelelli, and V. Mor. 2004. "Medicaid Payment and Risk-Adjusted Nursing Home Quality Measures." Health Affairs 23 (5): 243-52.
21. Grabowski, D. C., Z. Feng, O. Intrator, and V. Mor. 2004. "Recent Trends in State Nursing Home Payment Policies." Health Affairs Web Exclusives (June 16): W4-363-373.
22. Greenless, J. S., J. M. Marshall, and D. E. Yett. 1982. "Nursing Home Admissions Policies under Reimbursement." Bell Journal of Economics 13 (1): 93-106.
23. Gruenberg, L. W., and T. R. Willemain. 1982. "Hospital Discharge Queues in Massachusetts." Medical Care 20 (2): 188-201.
24. Harrington, C., J. H. Swan, V. Wellin, W. Clemena, and H. M. Carrillo. 1999. 1998 State Data Book on Long Term Care Program and Market Characteristics. San Francisco: Department of Social & Behavioral Sciences, University of California.
25. Harrington, C., D. Zimmerman, S. L. Karon, J. Robinson, and P. Beutel. 2000. "Nursing Home Staffing and Its Relationship to Deficiencies." Journal of Gerontology 55 (5): S278-87.
26. Holahan, J., and J. Cohen. 1987. "Nursing Home Reimbursement: Implications for Cost Containment, Access, and Quality." Milbank Quarterly 65 (1): 112-47.
27. Hsia, D. C., C. A. Ahern, B. P. Ritchie, L. M. Moscoe, and W. M. Krushat. 1992. "Medicare Reimbursement Accuracy under the Prospective Payment System, 1985 to 1988." Journal of the American Medical Association 268 (7): 896-9.
28. Hsia, D. C., W. M. Krushat, A. B. Fagan, J. A. Tebbutt, and R. P. Kusserow. 1988. "Accuracy of Diagnostic Coding for Medicare Patients under the Prospective-Payment System." New England Journal of Medicine 318 (6): 352-5.
29. Institute of Medicine. 1996. Nursing Staff in Hospitals and Nursing Homes: Is It Adequate?, pp. 128-68. Washington, DC: National Academy Press.
30. Kayser-Jones, J., E. Schell, W. Lyons, A. E. Kris, J. Chan, and R. L. Beard. 2003. "Factors That Influence End-of-Life Care in Nursing Homes: The Physical Environment, Inadequate Staffing, and Lack of Supervision." Gerontologist 43 Spec No 2: 76-84.
31. Konetzka, R. T., D. Yi, E. C. Norton, and K. E. Kilpatrick. 2004. "Effects of Medicare Payment Changes on Nursing Home Staffing and Deficiencies." Health Services Research 39 (3): 463-88.
32. Mor, V. 2004. "A Comprehensive Clinical Assessment Tool to Inform Policy and Practice: Applications of the Minimum Data Set." Medical Care 42 (4 Suppl): III50-9.
33. Mor, V., J. Zinn, J. Angelelli, J. M. Teno, and S. C. Miller. 2004. "Driven to Tiers: Socioeconomic and Racial Disparities in the Quality of Nursing Home Care." Milbank Quarterly 82 (2): 227-56.
34. Mukamel, D. B., and W. D. Spector. 2002. "The Competitive Nature of the Nursing Home Industry: Price Mark Ups and Demand Elasticities." Applied Economics 34 (4): 413-20.
35. Murtaugh, C. M., L. M. Cooney, R. R. Der Simonian, H. L. Smits, and R. B. Fetter. 1988. "Nursing Home Reimbursement and the Allocation of Rehabilitation Therapy Resources." Health Services Research 23 (4): 467-93.
36. Norton, E. C. 1992. "Incentive Regulation of Nursing Homes." Journal of Health Economics 11 (2): 105-28.
37. _. 2000. "Long-Term Care." In Handbook of Health Economics, edited by A. J. Cuyler and J. P. Newhouse, pp. 955-94. Amsterdam: Elsevier Science.
38. Nyman, J. A. 1988. "The Marginal Cost of Nursing Home Care, New York, 1983." Journal of Health Economics 7 (4): 393-412.
39. Office of the Inspector General. 1999. Quality of Care in Nursing Homes: An Overview. Washington, DC: U.S. Department of Health and Human Services.
40. _. 2001. Nursing Home Resident Assessment Quality of Care. Washington, DC: Office of the Inspector General.
41. Reid, W. M., and A. F. Coburn. 1996. "Managerial Responses to Medicaid Prospective Payment in the Nursing Home Sector." Hospital and Health Services Administration 41 (3): 283-96.
42. Reschovsky, J. D. 1996. "Demand for and Access to Institutional Long-Term Care: The Role of Medicaid in Nursing Home Markets." Inquiry 33 (1): 15-29.
43. Schlenker, R. E. 1986. "Case Mix Reimbursement for Nursing Homes." Journal of Health Politics, Policy, and Law 11 (3): 445-61.
44. _. 1991. "Nursing Home Costs, Medicaid Rates, and Profits under Alternative Medicaid Payment Systems." Health Services Research 26 (5): 623-49.
45. Schnelle, J. F. 2004. "Determining the Relationship between Staffing and Quality." Gerontologist 44 (1): 10-2.
46. Schnelle, J. F., S. F. Simmons, C. Harrington, M. Cadogan, E. Garcia, and B. M. Bates-Jensen. 2004. "Relationship of Nursing Home Staffing to Quality of Care." Health Services Research 39 (2): 225-50.
47. Shapiro, E., N. P. Roos, and S. Kavanagh. 1980. "Long Term Patients in Acute Care Beds: Is There a Cure?" Gerontologist 20 (3 Part 1): 342-9.
48. StataCorp. 2005. Stata Statistical Software: Release 9, pp. 244-65. College Station, TX: StataCorp LP.
49. Steinwald, B., and L. A. Dummit. 1989. "Hospital Case-Mix Change: Sicker Patients or DRG Creep?" Health Affair (Millwood) 8 (2): 35-47.
50. Strahan, G. W. 1997. "An Overview of Nursing Homes and Their Current Residents: Data from the 1995 National Nursing Home Survey." Advance Data (280): 1-12.
51. Swan, J. H., C. Harrington, W. Clemena, R. B. Pickard, L. Studer, and S. K. de Wit. 2000. "Medicaid Nursing Facility Reimbursement Methods: 1979-1997." Medical Care Research and Review 57 (3): 361-78.
52. Swan, J. H., and R. B. Pickard. 2003. "Medicaid Case-Mix Nursing Home Reimbursement in Three States." Journal of Health and Social Policy 16 (4): 27-53.
53. Thorpe, K. E., P. J. Gertler, and P. Goldman. 1991. "The Resource Utilization Group System: Its Effect on Nursing Home Case Mix and Costs." Inquiry 28 (4): 357-65.
54. Troyer, J. L. 2002. "Cross-Subsidization in Nursing Homes: Explaining Rate Differentials among Payer Types." Southern Economic Journal 68 (4): 750-73.
55. U.S. General Accounting Office. 1990. Nursing Homes: Admission Problems for Medicaid Recipients and Attempts to Solve Them. Washington, DC: U.S. General Accounting Office.
56. Weissert, W. G., and C. M. Cready. 1988. "Determinants of Hospital-to-Nursing Home Placement Delays: A Pilot Study." Health Services Research 23 (5): 619-47.
57. Wooldridge, J. M. 2002. Econometric Analysis of Cross Section and Panel Data, pp. 247-91. Cambridge, MA: MIT Press.
58. Zhang, X., and D. C. Grabowski. 2004. "Nursing Home Staffing and Quality under the Nursing Home Reform Act." Gerontologist 44 (1): 13-23.
59. Zimmerman, D. R., S. L. Karon, G. Arling, B. R. Clark, T. Collins, R. Ross, and F. Sainfort. 1995. "Development and Testing of Nursing Home Quality Indicators." Health Care Financing Review 16 (4): 107-27.
60. Zinn, J. S., V. Mor, O. Intrator, Z. Feng, J. Angelelli, and J. A. Davis. 2003. "The Impact of the Prospective Payment System for Skilled Nursing Facilities on Therapy Service Provision: A Transaction Cost Approach." Health Services Research 38 (6, part 1): 1467-85.