Care for the chronically ill: nursing home incentive payment experience

Area of Science:

• Health Services Research
• Healthcare Policy
• Gerontology

Background:

• Current nursing home reimbursement systems often fail to adjust payments to patient care needs.
• This leads to access barriers for patients requiring intensive care (heavy-care patients).
• Inefficient bed use and prolonged, costly hospital stays can result from inadequate reimbursement structures.

Purpose of the Study:

• To design and evaluate a novel patient-based nursing home incentive reimbursement system.
• To address restricted access for heavy-care patients.
• To mitigate inefficient bed utilization and suboptimal patient care.

Main Methods:

• A controlled field experiment was conducted across 36 skilled nursing facilities in California.
• The study evaluated a reimbursement system offering incentives for admitting heavy-care patients.
• Incentives were also provided for achieving patient outcome goals and facilitating community discharge and maintenance.

Main Results:

• The patient-based system is designed to simultaneously improve access for heavy-care patients.
• It aims to optimize the use of nursing home beds.
• The system seeks to enhance the quality of patient care and outcomes.

Conclusions:

• The developed reimbursement system offers a potential solution to critical challenges in nursing home care.
• It incentivizes providers to manage complex patient needs effectively.
• The controlled experimental design provides a robust approach to evaluating this social intervention.