Medicare payment changes and nursing home quality: effects on long-stay residents.
The Balanced Budget Act of 1997 dramatically changed the way that Medicare pays skilled nursing facilities, providing a natural experiment in nursing home behavior. Medicare payment policy (directed at short-stay residents) may have affected outcomes for long-stay, chronic-care residents if services for these residents were subsidized through cost-shifting prior to implementation of Medicare prospective payment for nursing homes. We link changes in both the form and level of Medicare payment at the facility level with changes in resident-level quality, as represented by pressure sores and urinary tract infections in Minimum Data Set (MDS) assessments. Results show that long-stay residents experienced increased adverse outcomes with the elimination of Medicare cost reimbursement.
Konetzka
R Tamara
RT
Department of Health Studies, University of Chicago, 5841 S. Maryland Ave., MC2007, Chicago, IL 60637, USA. konetzka@uchicago.edu
Norton
Edward C
EC
Stearns
Sally C
SC
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003361:Cost Allocation; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D008297:Male; D006278:Medicare / Q000331:legislation & jurisprudence*; D017059:Models, Econometric; D009735:Nursing Homes / Q000191:economics* / Q000706:statistics & numerical data; D003668:Pressure Ulcer / Q000191:economics / Q000453:epidemiology; D011445:Prospective Payment System / Q000331:legislation & jurisprudence*; D011787:Quality of Health Care / Q000191:economics* / Q000639:trends; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000191:economics / Q000453:epidemiology