The costs and potential savings associated with nursing home hospitalizations

Health Affairs

Volumn 26, Issue 6, 2007, Pages 1753-1761

  Grabowski, David C ^a   O'Malley, A James ^a   Barhydt, Nancy R ^b  

^a HARVARD MEDICAL SCHOOL   (United States)

^b NEW YORK STATE DEPARTMENT OF HEALTH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AGED; ARTICLE; COST CONTROL; CROSS-SECTIONAL STUDY; ECONOMICS; EPIDEMIOLOGY; FEMALE; GERIATRIC ASSESSMENT; HEALTH SERVICE; HOSPITALIZATION; HUMAN; MALE; NURSING HOME; STATISTICS; UNITED STATES;

AGED; AGED, 80 AND OVER; COST SAVINGS; CROSS-SECTIONAL STUDIES; FEMALE; GERIATRIC ASSESSMENT; HEALTH CARE SURVEYS; HEALTH SERVICES MISUSE; HOSPITALIZATION; HUMANS; MALE; NEW YORK; NURSING HOMES; UNITED STATES;

EID: 36849081338     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.6.1753     Document Type: Article

References (29)

1. Long-stay residents were identified by the authors as those in a nursing home for at least 160 days. O. Intrator, J. Zinn, and V. Mor, "Nursing Home Characteristics and Potentially Preventable Hospitalizations of Long-Stay Residents," Journal of the American Geriatrics Society 52, no. 10 (2004): 1730-1736.
2. D. Saliba et al., "Appropriateness of the Decision to Transfer Nursing Facility Residents to the Hospital," Journal of the American Geriatrics Society 48, no. 2 (2000): 154-163.
3. J.G. Ouslander, A.D. Weinberg, and V. Phillips, "Inappropriate Hospitalization of Nursing Facility Residents: A Symptom of a Sick System of Care for Frail Older People," Journal of the American Geriatrics Society 48, no. 2 (2000): 230-231.
4. "Potentially avoidable" hospitalizations are acute conditions that can be prevented via better primary care in the nursing home and conditions that can be treated in the nursing home given sufficient resources.
5. R.L. Kane et al., "The Effect of Evercare on Hospital Use," Journal of the American Geriatrics Society 51, no. 10 (2003): 1427-1434.
6. E.A. Miller and W.G. Weissert, "Strategies for Integrating Medicare and Medicaid: Design Features and Incentives," Medical Care Research and Review 60, no. 2 (2003): 123-157.
7. Abt Associates, Nursing Home Pay-for-Performance Demonstration Draft Design: Open Door Forum, September 20, 2005, http://www.cms.hhs.gov/ DemoProjectsEvalRpts/downloads/NHP4P_Handout.pdf (accessed 8 August 2007).
8. New York facilities generally have higher occupancy rates, higher proportion of Medicaid residents, and fewer for-profit and chain-owned facilities than those elsewhere. C. Harrington, H. Carillo, and C. Mercado-Scott, "Nursing Facilities, Staffing, Residents, and Facility Deficiencies, 1998 through 2004" (San Francisco: Department of Social and Behavioral Sciences, University of California, 2005).
9. P. Gillen et al., "Functional and Residential Status Transitions among Nursing Home Residents," Journals of Gerontology, Series A: Biological Sciences and Medical Sciences 51, no. 1 (1996): M29-M36.
10. S.D. Culler, M.L. Parchman, and M. Przybylski, "Factors Related to Potentially Preventable Hospitalizations among the Elderly," Medical Care 36, no. 6 (1998): 804-817.
11. M.W. Carter, "Factors Associated with Ambulatory Care-Sensitive Hospitalizations among Nursing Home Residents," Journal of Aging and Health 15, no. 2 (2003): 295-331;
12. and Intrator et al., "Nursing Home Characteristics.
13. D.C. Grabowski et al., "Recent Trends in State Nursing Home Payment Policies," Health Affairs 23 (2004): w363-w373 (published online 16 June 2004; 10.1377/hlthaff.w4.363).
14. P.I. Buerhaus, D.O. Staiger, and D.I. Auerbach, "Implications of an Aging Registered Nurse Workforce," Journal of the American Medical Association 283, no. 22 (2000): 2948-2954.
15. D.G. Stevenson and D.M. Studdert, "The Rise of Nursing Home Litigation: Findings from a National Survey of Attorneys," Health Affairs 22, no. 2 (2003): 219-229.
16. R.T. Konetzka et al., "Medicare Prospective Payment and Quality of Care for Long-Stay Nursing Facility Residents," Medical Care 44, no. 3 (2006): 270-276.
17. In an analysis of short-stay nursing home rehospitalization rates for five conditions during 2000-2004, there was a relative increase of 50.5 percent in rehospitalization rates within thirty days and a relative increase of 45 percent within 100 days. N. Donelan-McCall et al., "Small Patient Population and Low Frequency Event Effects on the Stability of SNF Quality Measures," in Final Report (Washington: Medicare Payment Advisory Commission, 2006).
18. N.G. Castle and V. Mor, "Hospitalization of Nursing Home Residents: A Review of the Literature, 1980-1995,"Medical Care Research and Review 53, no. 2 (1996): 123-148;
19. Kane et al., "The Effect of Evercare on Hospital Use"; and M. Loeb et al., "Effect of a Clinical Pathway to Reduce Hospitalizations in Nursing Home Residents with Pneumonia: A Randomized Controlled Trial," Journal of the American Medical Association 295, no. 21 (2006): 2503-2510.
20. O. Intrator et al., "Hospitalization of Nursing Home Residents: The Effects of States' Medicaid Payment and Bed-Hold Policies," Health Services Research 42, no. 4 (2007): 1651-1671;
21. and O. Intrator and V. Mor, "Effect of State Medicaid Reimbursement Rates on Hospitalizations from Nursing Homes," Journal of the American Geriatrics Society 52, no. 3 (2004): 393-398.
22. Although there may be less financial incentive for state Medicaid agencies to provide nursing homes with the clinical resources necessary to prevent avoidable hospitalizations, there may still be a rationale for such an investment from the perspective of quality improvement.
23. Miller and Weissert, "Strategies for Integrating Medicare and Medicaid."
24. The existing empirical literature offers little evidence to support the effectiveness of paying for quality in the health care sector. M.B. Rosenthal and R.G. Frank, "What Is the Empirical Basis for Paying for Quality in Health Care?" Medical Care Research and Review 63, no. 2 (2006): 135-157.
25. X. Zhang and D.C. Grabowski, "Nursing Home Staffing and Quality under the Nursing Home Reform Act," Gerontologist 44, no. 1 (2004): 13-23.
26. D.B. Mukamel and W.D. Spector, "Quality Report Cards and Nursing Home Quality," Gerontologist 43 Spec. no. 2 (2003): 58-66.
27. Intrator et al., "Hospitalization of Nursing Home Residents."
28. To estimate the Medicare payment received by the hospital, we applied the hospital-specific diagnosis-related group (DRG) payment rules to all Medicare-covered patients in our study. Based on this check (available from the authors), Medicare hospital costs were a good approximation for payments in the aggregate. Research Data Assistance Center, "Calculating Hospital Specific DRG Adjusted Payments (DRG Prices)," in Technical Brief, Pub. no. TN-004-1 (Minneapolis: University of Minnesota, 2006).
29. M.W. Carter, "Variations in Hospitalization Rates among Nursing Home Residents: The Role of Discretionary Hospitalizations," Health Services Research 38, no. 4 (2003): 1177-1206; and Saliba et al., "Appropriateness of the Decision."