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Periodic medical review: the impact in Pennsylvania
Abstract:
Periodic Medical Review (PMR) of all Medicaid beneficiaries in skilled nursing facilities (SNFs) in Pennsylvania was implemented in fiscal year 1973-74. In this study, the authors explored the impact of PMR through its first four annual review periods. Because over two thirds of all SNF patients who were determined (over the four-year period) to require lower levels of care were identified during the first year of the program, the study was focused on the impact of first-year reviews on patient placements and nursing home industry characteristics in the subsequent years. Although the results did not strongly show that PMR had significant long-term effects, the general conclusions reached were that: 1) first year PMR decisions altered (in the intended direction) SNF patient placements and structural characteristics of the nursing home industry in Pennsylvania; 2) the initial impact of PMR was still apparent by the fourth year, but much weaker; and 3) the PMR review team may have been more lenient in their decisions concerning appropriate levels of care for reviewed SNF patients after the first year.
Insights
Periodic Medical Review (PMR) in Pennsylvania skilled nursing facilities (SNFs) initially improved patient placements. However, the long-term impact of these reviews on SNF patient care levels and industry characteristics was limited.
Area of Science:
- Health Services Research
- Gerontology
- Public Health Policy
Background:
- Periodic Medical Review (PMR) was mandated for Medicaid beneficiaries in Pennsylvania skilled nursing facilities (SNFs) starting in fiscal year 1973-74.
- The study examines the impact of PMR over its initial four annual review periods.
Purpose of the Study:
- To explore the impact of Periodic Medical Review on patient placements and the nursing home industry.
- To analyze the effects of first-year PMR reviews on subsequent years.
Main Methods:
- Analysis of patient placement data and nursing home industry characteristics.
- Focus on the first four annual review periods of the PMR program.
Main Results:
- Over two-thirds of patients requiring lower care levels were identified in the first year.
- First-year PMR decisions positively influenced SNF patient placements and industry structure.
- The initial impact of PMR weakened by the fourth year.
- Potential leniency in review decisions after the first year was observed.
Conclusions:
- PMR's initial implementation in Pennsylvania SNFs altered patient placements and industry characteristics.
- The long-term effects of PMR were not strongly significant, though initial impacts persisted weakly.
- Review team leniency may have influenced care level decisions in later years.