Nursing Home COVID Relief Under QIP's Performance-Based Formula: Does Performance Actually Matter, and Should It?

Area of Science:

• Public Health
• Health Policy
• Gerontology

Background:

• The Quality Incentive Program (QIP) aimed to incentivize nursing homes (NHs) to reduce COVID-19 infections.
• Understanding the impact of such financial incentives on NH operations and outcomes is crucial for public health policy.

Purpose of the Study:

• To evaluate the effect of the QIP on nursing homes.
• To determine the association between QIP payments and NH COVID-19 related attributes.
• To identify facility and community factors influencing QIP distribution.

Main Methods:

• Analysis of data from 15,331 nursing homes.
• Examination of QIP payments per resident-week (QIP$) in relation to county and facility COVID-19 infection rates.
• Regression analyses to assess the association between QIP$ and NH practices (PPE, testing, admissions).

Main Results:

• QIP payments were primarily linked to county-level infection rates, not facility-level rates.
• Larger QIP payments were observed for smaller, nonprofit NHs in rural, economically distressed areas.
• NHs receiving higher QIP$ demonstrated better COVID-19 mitigation strategies, including increased PPE, staff testing, and restricted admissions of infected residents.

Conclusions:

• The QIP's effectiveness in incentivizing facility-level infection control is questionable due to its reliance on county-level data.
• Performance-based payment systems may require refinement for optimal impact during public health emergencies.
• NHs with greater resources and proactive mitigation strategies were more likely to receive QIP payments.