A comparison of skilled nursing facility rehabilitation treatment and outcomes under Medicare managed care and Medicare fee-for-service reimbursement.
OBJECTIVE
This article compares the rehabilitation treatment and outcomes of Medicare managed care organization (MCO) and fee-for-service (FFS) patients in skilled nursing facilities (SNFs).


METHODS
Data on 514 MCO patients and 420 FFS patients treated in four for-profit Southern California-based SNFs between June 1996 and September 1998 were analyzed with bivariate and multivariate regression models.


RESULTS
After controlling for time since onset and other sociodemographic and health status characteristics, Medicare MCO patients were found to receive significantly fewer therapy units and have significantly shorter lengths of stay in rehabilitation programs.


CONCLUSIONS
The findings may be the result of more global differences in the trajectories of care among MCO and FFS patients treated in SNFs, yet they highlight critical issues related to the spread of Medicare managed care in nursing homes and the dynamic between MCO and FFS reimbursement systems.
Angelelli
J J
JJ
Brown University, Center for Gerontology and Health Care Research, Providence, Rhode Island 20912, USA. Joseph_Angelelli@brown.edu
Wilber
K H
KH
Myrtle
R
R
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002140:California; D018588:Fee-for-Service Plans / Q000191:economics / Q000592:standards*; D005260:Female; D006302:Health Services Research; D006304:Health Status; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000592:standards*; D006278:Medicare / Q000191:economics / Q000592:standards*; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D012044:Regression Analysis; D012046:Rehabilitation / Q000191:economics / Q000592:standards*; D012866:Skilled Nursing Facilities / Q000191:economics / Q000592:standards*; D012959:Socioeconomic Factors