title: Incentives in case-mix measures for long-term care.
abstract: Several States now use patient-based payments for skilled nursing facilities and intermediate care facilities; others are in the process of developing case-mix systems. The Health Care Financing Administration is working under congressional mandate to develop a prospective case-mix system for Medicare payments to skilled nursing facilities. If new payment methods follow the existing pattern, they will be based not on the patient's clinical characteristics but rather on a mixture of clinical characteristics and services delivered. As a result, innate incentives are contained in data collection systems which are cost-increasing at best and dangerous at worst. A preferable approach would be to develop payment schemes based on the patient's degree of dependence.
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S.; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups; D007380:Intermediate Care Facilities / Q000191:economics*; D006278:Medicare; D009735:Nursing Homes / Q000191:economics*; D011445:Prospective Payment System / Q000379:methods*; D012051:Reimbursement Mechanisms / Q000379:methods*; D012866:Skilled Nursing Facilities / Q000191:economics*; D014481:United States; D014903:West Virginia