Nurse staffing levels and Medicaid reimbursement rates in nursing facilities.
OBJECTIVE
To examine the relationship between nursing staffing levels in U.S. nursing homes and state Medicaid reimbursement rates.


METHODS
Facility staffing, characteristics, and case-mix data were from the federal On-Line Survey Certification and Reporting (OSCAR) system and other data were from public sources.


METHODS
Ordinary least squares and two-stage least squares regression analyses were used to separately examine the relationship between registered nurse (RN) and total nursing hours in all U.S. nursing homes in 2002, with two endogenous variables: Medicaid reimbursement rates and resident case mix.


RESULTS
RN hours and total nursing hours were endogenous with Medicaid reimbursement rates and resident case mix. As expected, Medicaid nursing home reimbursement rates were positively related to both RN and total nursing hours. Resident case mix was a positive predictor of RN hours and a negative predictor of total nursing hours. Higher state minimum RN staffing standards was a positive predictor of RN and total nursing hours while for-profit facilities and the percent of Medicaid residents were negative predictors.


CONCLUSIONS
To increase staffing levels, average Medicaid reimbursement rates would need to be substantially increased while higher state minimum RN staffing standards is a stronger positive predictor of RN and total nursing hours.
Harrington
Charlene
C
Department of Social & Behavioral Sciences, University of California, San Francisco, CA 94118, USA.
Swan
James H
JH
Carrillo
Helen
H
D014487:Centers for Medicare and Medicaid Services, U.S.; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008484:Medicaid / Q000191:economics*; D009740:Nursing Staff / Q000191:economics / Q000600:supply & distribution*; D010561:Personnel Staffing and Scheduling / Q000191:economics* / Q000706:statistics & numerical data; D011907:Rate Setting and Review; D012044:Regression Analysis; D012866:Skilled Nursing Facilities / Q000191:economics / Q000706:statistics & numerical data; D014481:United States; D000078329:Workforce