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MDS-based state Medicaid reimbursement and the ADL-decline quality indicator
Nicole M Bellows1, Helen A Halpin
1Center for Health and Public Policy Studies, University of California Berkeley, School of Public Health.
Purpose:
We examined the relationship between the quality indicator for decline in activities of daily living (ADL) and the use of the Minimum Data Set (MDS) for determining Medicaid skilled nursing facility reimbursement.
Design And Methods:
We conducted a cross-sectional analysis using the 2004 National MDS Facility Quality Indicator reports as the dependent variable in a multilevel regression model. Our primary explanatory variable was a state-level binary variable distinguishing whether or not the state used an MDS-based Medicaid-reimbursement system in 2004. We obtained control variables through the Online Survey, Certification, and Reporting System.
Results:
Skilled nursing facilities located in states that used the MDS for Medicaid reimbursement reported more ADL decline than did facilities in states that did not use the MDS for reimbursement.
Implications:
The finding suggests that the ADL-decline quality indicator captures more than just quality, including state-level policy differences. Therefore, the ADL-decline quality indicator should be investigated and refined prior to being relied on for pay-for-performance initiatives.
Insights
States using the Minimum Data Set (MDS) for Medicaid reimbursement reported higher rates of activities of daily living (ADL) decline in skilled nursing facilities. This suggests the ADL quality indicator reflects policy differences, not just care quality.
Area of Science:
- Gerontology
- Health Services Research
- Public Policy
Background:
- Skilled nursing facility (SNF) reimbursement is often tied to quality indicators.
- The Minimum Data Set (MDS) is a tool used in SNFs to collect patient data.
- Activities of Daily Living (ADL) decline is a key quality indicator in SNFs.
Purpose of the Study:
- To examine the relationship between the ADL decline quality indicator and the use of MDS for Medicaid reimbursement in SNFs.
- To determine if state-level Medicaid policies influence ADL quality indicator reporting.
Main Methods:
- Cross-sectional analysis of 2004 National MDS Facility Quality Indicator reports.
- Multilevel regression model with ADL decline as the dependent variable.
- State-level binary variable for MDS-based Medicaid reimbursement as the primary explanatory variable.
Main Results:
- SNFs in states utilizing MDS for Medicaid reimbursement reported significantly more ADL decline.
- This association suggests policy variations impact the ADL quality indicator.
Conclusions:
- The ADL-decline quality indicator may capture factors beyond actual care quality, such as state policy differences.
- Further investigation and refinement of the ADL-decline indicator are necessary before its use in pay-for-performance initiatives.
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