RUGs II: implications for management and quality in long term care.
Case-mix-based reimbursement could provide long term care facilities with a financial incentive to accept the more acutely ill patients who are being discharged from hospitals under Medicare's prospective payment system. But a financial incentive to maintain a complex case mix could also encourse nursing homes to provide substandard care. New York's Medicaid program has coupled a reimbursement method based on Resourse Utilizationm Groups (RUGs II) with regulatory efforts to ensure quality in a model that may be be adopted by Medicare and by Medicaid programs in other states. This article describes New York's system and discusses a number of management and quality assurance strategies that may be useful to nursing homes under RUGs II.
D000203:Activities of Daily Living; D003953:Diagnosis-Related Groups / Q000379:methods*; D006801:Humans; D008134:Long-Term Care / Q000145:classification* / Q000592:standards; D009518:New York; D009735:Nursing Homes / Q000191:economics*; D010347:Patient Care Planning; D011785:Quality Assurance, Health Care; D011996:Records; D012051:Reimbursement Mechanisms