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Case mix reimbursement for nursing homes.
Journal of Health Politics, Policy and Law
|January 1, 1986
Summary
Nursing home care costs are linked to patient complexity and quality. Current reimbursement may hinder access and quality for Medicaid recipients, prompting new case-mix-based payment models for policy consideration.
Area of Science:
- Healthcare Management
- Health Economics
- Geriatric Care
Background:
- Aging population driving increased demand for nursing home care.
- Medicare's prospective payment system incentivizes early hospital discharges to nursing facilities.
- Medicaid is the primary payer for approximately half of all nursing home services.
Purpose of the Study:
- To examine the relationship between patient case mix, healthcare costs, and quality in nursing homes.
- To evaluate the impact of traditional reimbursement methodologies on access and quality for Medicaid beneficiaries.
- To assess the potential of case-mix-adjusted reimbursement models.
Main Methods:
- Review of existing research on nursing home cost, quality, and reimbursement.
- Analysis of the association between case mix and cost.
- Analysis of the association between quality and cost.
Main Results:
- A strong positive association exists between patient case mix and nursing home costs.
- A weaker but positive association was found between quality and cost.
- Traditional reimbursement models may negatively impact access and quality for Medicaid and Medicare recipients.
Conclusions:
- Nursing home reimbursement policy significantly impacts care access and quality.
- Incorporating case mix into reimbursement is a promising strategy to address current system limitations.
- State-level implementation of case-mix reimbursement warrants careful policy evaluation and consideration.