Medicare's prospective payment system for skilled nursing facilities: effects on staffing and quality of care.
In 1998, Medicare began phasing in a new prospective payment system (PPS) for skilled nursing facilities (SNFs). This paper measures facility-level changes in nurse staffing and quality at freestanding SNFs from 1997 (pre-PPS) to 2001 (post-PPS). Findings show a positive but small association between changes in payment levels and changes in nurse staffing. Among for-profits, the elimination of cost reimbursement is associated with a large drop in nurse staffing. Additionally, the elimination of cost reimbursement is associated with worsening in one of four measures of quality of care; however, the quality results are not statistically robust.
White
Chapin
C
Congressional Budget Office, USA. chapin_white@post.harvard.edu
D006801:Humans; D006278:Medicare / Q000458:organization & administration*; D015233:Models, Statistical; D010561:Personnel Staffing and Scheduling / Q000191:economics*; D011445:Prospective Payment System; D011787:Quality of Health Care; D012866:Skilled Nursing Facilities / Q000191:economics; D014481:United States; D000078329:Workforce