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Case mix for nursing home payment: resource utilization groups, version II.

D P Schneider, B E Fries, W J Foley

    Health Care Financing Review
    |November 5, 1988
    PubMed
    Summary
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    A new resident classification system was developed for New York nursing homes. This system uses clinical and administrative data to improve Medicaid payments and facility management.

    Area of Science:

    • Gerontology
    • Health Services Research
    • Healthcare Management

    Background:

    • Nursing home resident classification is complex, requiring consideration of diverse factors.
    • Accurate resident assessment is crucial for appropriate resource allocation and quality care in long-term facilities.
    • Existing payment systems may not fully capture the nuances of resident needs and resource utilization.

    Purpose of the Study:

    • To develop and validate a resident classification system for nursing homes in New York State.
    • To create a system that balances clinical, statistical, and administrative criteria for payment purposes.
    • To enhance the utility of the system for Medicaid payment, quality of care, and facility management.

    Main Methods:

    • A study involving 3,427 nursing home residents in New York State was conducted.

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  • Data collected included resident characteristics and resources utilized.
  • Statistical and administrative criteria were integrated with clinical data.
  • Main Results:

    • A novel resident classification system was successfully developed.
    • The system demonstrated utility for New York State's Medicaid payment system.
    • The classification system is applicable to quality of care assessments and facility management.

    Conclusions:

    • The developed resident classification system offers a balanced approach using multiple criteria.
    • This system provides a valuable tool for optimizing nursing home operations and reimbursement.
    • The findings support the integration of clinical, statistical, and administrative data for effective healthcare management.