Medicaid payment policies for nursing home care: a national survey.
PubMedPublished 1 January 1991Open access
Robert J. Buchanan, R P Madel, Donald S Persons
Citations35
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
This research gives a comprehensive overview of the nursing home payment methodologies used by each State Medicaid program, and discusses the impact these different methodologies have on program cost containment, quality, and recipient access.
Abstract
This research gives a comprehensive overview of the nursing home payment methodologies used by each State Medicaid program. To present this comprehensive overview, 1988 data were collected by survey from 49 States and the District of Columbia. The literature was reviewed and integrated into the study to provide a theoretical framework to analyze the collected data. The data are organized and presented as follows: payment levels, payment methods, payment of capital-related costs, and incentives in nursing home payment. We conclude with a discussion of the impact these different methodologies have on program cost containment, quality, and recipient access.
Keywords
Social SciencesHealth ProfessionsEconomics, Econometrics and Finance
PubMedNational health expenditures, 1984.
74 Citations1985Katharine R. Levit, Helen C. Lazenby +2 more
Growth in health care expenditures slowed to 9.1 percent in 1984, the smallest increase in expenditures in 19 years, and economic forces and emerging structural changes within the health sector played a role.
PubMedNursing home cost studies and reimbursement issues.
66 Citations1980Christine E. Bishop
This review of nursing home cost function research shows that certain provider and service characteristics are systematically associated with differences in the average cost of care, and this information can be used to group providers for reasonable cost related rate-setting or to adjust their rates or rate ceilings.
Medical CareWhy Do Nursing Home Costs Vary?
50 Citations1981Howard G. Birnbaum, Christine E. Bishop +2 more
The analyses indicate that facility size and occupancy rate are minimally important in determing cost variation, and facility characteristics, particularly type of facility and ownership, are important variables.
Social Science & MedicineAn econometric analysis of the major determinants of nursing home costs in the United States
49 Citations1982Mark R. Meiners
Statistical cost function estimates based on data from the 1973-74 National Nursing Home Survey are presented and evidence is provided which suggests that residents with mid-level dependency are relatively more costly to treat than those who are completely dependent or independent.
PubMedNursing home cost and ownership type: evidence of interaction effects.
45 Citations1987Greg Arling, Richard H. Nordquist +1 more
The analysis revealed interaction effects between ownership and other predictor variables, with predictor variables having different effects on cost depending on ownership type, and the implications for long-term care reimbursement policies are discussed.
Milbank QuarterlyNursing Home Reimbursement: Implications for Cost Containment, Access, and Quality
44 Citations1987John Holahan, Joel W. Cohen
The individual states have many options in designing Medicaid reimbursement systems for nursing homes, and each option has a differential effect on incentives--and outcomes--for containing costs, providing quality care, and maintaining access to care.
Medical CareCase-mix and Resource Use in Long-term Care
38 Citations1985James M. Cameron
The relatively high variance reduction achieved in the creation of a limited number of groups demonstrates the feasibility of developing measures of case mix based on patient resource use for long-term care.
PubMedState Medicaid reimbursement for nursing homes, 1978-86.
31 Citations1988James H. Swan, Charlene Harrington +1 more
A cross-sectional time series regression analysis of Medicaid reimbursement rates on methods showed that States using prospective class reimbursement had significantly lower rates for the period 1982-86 than retrospective methods in 1983-84.
PubMedCost analysis and facility reimbursement in the long-term health care industry.
25 Citations1984Steven G. Ullmann
The author examines in depth the cost effects of patient mix and facility quality and estimates cost savings and predicted improvements in facility performance resulting from adoption of a prospective reimbursement system.
Journal of Health Politics Policy and LawState Rate-Setting and Its Effects on the Cost of Nursing-Home Care
23 Citations1985John Holahan
Analysis of nursing-home cost reports finds that homes in states with flat-rate reimbursement systems were found to have lower rates of increase than homes in other states, while there were no consistent differences between the results of prospective and retrospective systems.
American Journal of Public HealthState Medicaid coverage of AZT and AIDS-related policies.
21 Citations1988Robert J. Buchanan
Most states do not have special Medicaid coverage for AIDS care nor are they developing proposals or policies for this care, however, a number of states are developing or implementing AIDS-related policies through their Medicaid programs.
PubMedMedicaid nursing home reimbursement policies, rates, and expenditures.
19 Citations1984Charlene Harrington, James H. Swan
Nursing home expenditures, along with those of hospitals, have been a target of cost containment efforts because they constitute a growing share of overall public expenditures for health.
Medical CareRUGs and Equity of Access to Nursing Home Care
16 Citations1987John A. Nymann, Samuel Levey +1 more
Evidence is presented that suggests that the presence of excess demand, rather than low reimbursement rates, causes nursing homes to exclude the more costly Medicaid patients.
PubMedCost analysis of the Ohio nursing home industry.
15 Citations1983Rachel J Caswell, William O. Cleverley
This study was part of a major review of long-term care policy in the state of Ohio and found that skilled facilities were more costly than intermediate care facilities (ICFs), and the differential was large enough to suggest transfer of misplaced patients.
PubMedThe determinants of nursing home operating costs in New York State.
14 Citations1983Amanda Jayne Lee, Howard G. Birnbaum
The analysis indicates that "scale" and occupancy are minimally important in determining operating cost variation, and patient- and service-mix differences are found to be important, although reimbursement grouping variables (e.g., profit/nonprofit) remain the most significant and important variables.
PubMedReturn to nursing home investment: issues for public policy.
8 Citations1984Carliss Y. Baldwin, Christine E. Bishop
Because Government policy does much to determine the return available to nursing home investment, the profitability of the nursing home industry has been a subject of controversy since Government agencies began paying a large portion of the Nation's nursing home bill.
PubMedAn evaluation of current approaches to nursing home capital reimbursement.
8 Citations1986J Cohen, John Holahan
It is concluded that newer approaches that recognize the increasing value of nursing home assets over time, commonly called fair rental systems, are preferable to the methodologies that have been used historically in both the Medicare and the Medicaid programs to set capital rates.
PubMedCase-mix reimbursement for nursing home services: simulation approach.
7 Citations1986Adams Ek, Schlenker Re
A simulation model is used to replicate payments under the case-mix systems used in Maryland, Ohio, and West Virginia and indicates that these systems would better relate dollar payments to measure patient need, and for-profit homes would benefit relative to nonprofit homes.
PubMedMedicaid cost containment: prospective reimbursement for long-term care.
5 Citations1983Buchanan Rj
This study analyzes the impact of prospective rate setting by state programs on Medicaid payment and utilization rates for long-term care and finds that for each year between 1975 and 1982, the use of prospective reimbursement was always associated with lower Medicaid payments for long -term care without adversely affecting recipient access to care.
PubMedMedicaid cost containment: long term care reimbursement.
5 Citations1983Robert J. Buchanan
Research on the effect of a broad range of reimbursement, health, wage, and socioeconomic factors on Medicaid payment and utilization rates for long-term care from 1976 to 1984 is presented and analyzed.
PubMedFair rental systems: paying nursing homes for capital costs.
1 Citations1987Grimaldi Pl, Jazwiecki Tj
Although it is too early to tell which approach is best, one point seems clear--a fair rental system can be a distinct improvement over cost-based reimbursement, depending on design and administration.