Medicare's prospective payment system for hospitals: the impact on nursing home quality

How are changes in Medicare affecting the quality of long term care? Finding an answer to this question is made difficult by the many variables that must be considered and the lack of concrete data on the subject. The variables include the care requirements of Medicare patients being discharged from hospitals to nursing homes, the availability and accessibility of skilled-care beds, the trends in utilization of skilled-care beds, and the capability of nursing homes to provide the care required by these patients. Anecdotal data suggest that Medicare patients are being discharged from hospitals earlier, sicker, and with more complex skilled nursing requirements than before the implementation of prospective payment, that there has been limited collaboration among hospitals and nursing homes during this period of transition in the Medicare system, and that nursing home administrators and staffs are increasingly concerned about the actual cost of providing care to a sicker group of patients and about the qualifications of staff to meet more complex care needs. One positive outgrowth of this situation is an increase in collaboration among hospitals and nursing homes. Nursing home staff are now more apt to visit a patient in the hospital to perform a preadmission assessment. Such collaboration can help avoid inappropriate nursing home admissions and improve continuity of care for patients who are admitted.(ABSTRACT TRUNCATED AT 250 WORDS)