Impact of Medicaid reimbursement on mental health quality indicators.
OBJECTIVE
To examine the relationship between the use of the Minimum Data Set (MDS) for determining Medicaid reimbursement to nursing facilities and the MDS Quality Indicators examining nursing facility residents' mental health.


METHODS
The 2004 National MDS facility Quality Indicator reports served as the dependent variables. Explanatory variables were based on the 2004 Online Survey Certification and Reporting system (OSCAR) and an examination of existing reports, a review of the State Medicaid Plans, and State Medicaid personnel.


METHODS
Multilevel regression models were used to account for the hierarchical structure of the data.


METHODS
MDS and OSCAR data were linked by facility identifiers and subsequently linked with state-level variables.


RESULTS
The use of the MDS for determining Medicaid reimbursement was associated with higher (poorer) quality indicator values for all four mental health quality indicators examined. This effect was not found in four comparison quality indicators.


CONCLUSIONS
The findings indicate that documentation of mental health symptoms may be influenced by economic incentives. Policy makers should be cautioned from using these measures as the basis for decision making, such as with pay-for-performance initiatives.
Bellows
Nicole M
NM
Center for Health and Public Policy Studies, University of California, Berkeley, 140 Warren Hall #7360, Berkeley, CA 94720-7360, USA.
Halpin
Helen A
HA
D000928:Antidepressive Agents / Q000627:therapeutic use; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000458:organization & administration; D003072:Cognition Disorders / Q000175:diagnosis / Q000628:therapy; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy; D003953:Diagnosis-Related Groups; D006302:Health Services Research; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008484:Medicaid; D008603:Mental Health; D009735:Nursing Homes / Q000191:economics / Q000458:organization & administration*; D019984:Quality Indicators, Health Care / Q000458:organization & administration*; D014481:United States
D000928:Antidepressive Agents