Medicare cost differences between nursing home patients admitted with and without dementia.
OBJECTIVE
Our objective in this study was to compare Medicare costs of treating older adults with and without dementia in nursing home settings.


METHODS
An expert panel established the dementia status of a stratified random sample of newly admitted residents in 59 Maryland nursing homes between 1992 and 1995. Medicare expenditures per-person month (PPM) were compared for 640 residents diagnosed with dementia and 636 with no dementia for 1 year preadmission and 2 years postadmission. Multivariate analysis with generalized estimating equations was used to identify the source of Medicare cost differentials between the two groups.


RESULTS
Medicare expenditures peaked in the month immediately preceding admission and dropped to preadmission levels by the third month in a nursing home. Adjusted PPM costs postadmission for the dementia group as a whole were 79% (p < .001) of the Medicare costs of treating residents without dementia. For the subgroup of residents admitted without a Medicare qualified stay (MQS), those with dementia had Medicare costs of just 63% (p < .001) of those without dementia. Overall Medicare costs PPM were insignificantly different between the two groups admitted with a MQS.


CONCLUSIONS
Whether nursing home residents are admitted with a MQS is the single most important factor in assessing treatment cost differentials between residents admitted with and without dementia. Failure to consider this factor may lead researchers and policy makers to misdirect their attention from the true source of the differential-dementia patients admitted without a qualifying stay.
Stuart
Bruce
B
The Peter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, 515 W. Lombard Street, Suite 157, Baltimore, MD 21201, USA. bstuart@rx.umaryland.edu
Gruber-Baldini
Ann L
AL
Fahlman
Cheryl
C
Quinn
Charlene C
CC
Burton
Lynda
L
Zuckerman
Illene H
IH
Hebel
J Rich
JR
Zimmerman
Sheryl
S
Singhal
Puneet K
PK
Magaziner
Jay
J
D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000191:economics* / Q000451:nursing; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008396:Maryland; D006278:Medicare / Q000191:economics*; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000191:economics*