Changing Patient Medical Complexity After Skilled Nursing Facility Payment Reform: An Interrupted Time Series...

Area of Science:

• Health Services Research
• Gerontology
• Health Economics

Background:

• Medicare's Patient-Driven Payment Model (PDPM) aimed to incentivize skilled nursing facilities (SNFs) to admit more medically complex patients.
• The impact of PDPM on SNF case-mix and potential disparities based on SNF quality ratings remains unclear.

Purpose of the Study:

• To evaluate whether the PDPM implementation led to changes in SNF case-mix.
• To determine if SNF quality ratings influenced the response to PDPM regarding case-mix adjustments.

Main Methods:

• Analysis of Medicare fee-for-service data from January 2018 to February 2020.
• Case-mix was assessed using measures of medical complexity, including reasons for admission (medical management, total joint replacements), dementia diagnoses, and the non-therapy ancillary (NTA) score.
• Interrupted time series models examined case-mix changes post-PDPM, considering SNF quality (low vs. average/high).

Main Results:

• PDPM was associated with increased admissions for medical management and decreased admissions for uncomplicated total joint replacements across all SNFs.
• Low-quality SNFs exhibited smaller shifts in case-mix compared to average/high-quality SNFs.
• PDPM led to a reduction in dementia patient admissions, particularly in low-quality SNFs, and a slight increase in NTA scores.

Conclusions:

• PDPM successfully shifted SNF admissions toward more medically complex patients.
• Lower-quality SNFs were less responsive to PDPM incentives, indicating potential access disparities.
• The PDPM may create additional barriers for dementia patients seeking SNF care.