Maintaining continuity of care for nursing home residents: effect of states' Medicaid bed-hold policies and reimbursement rates.
OBJECTIVE
Recent public concern in response to states' intended repeal of Medicaid bed-hold policies and report of their association with higher hospitalization rates prompts examination of these policies in ensuring continuity of care within the broader context of Medicaid policies.


METHODS
Minimum Data Set assessments of long-stay nursing home residents in April-June 2000 linked to Medicare claims enabled tracking residents' hospitalizations during the ensuing 5 months and determining hospital discharge destination. Multinomial multilevel models estimated the effect of state policies on discharge destination controlling for resident, hospitalization, nursing home, and market characteristics.


RESULTS
Among 77,955 hospitalizations, 5,797 (7.4 percent) were not discharged back to the baseline nursing home. Bed-hold policies were associated with lower odds of transfer to another nursing home (AOR=0.55, 95 percent CI 0.52-0.58) and higher odds of hospitalization (AOR=1.36), translating to 9.5 fewer nursing home transfers and 77.9 more hospitalizations per 1,000 residents annually, and costing Medicaid programs about $201,311. Higher Medicaid reimbursement rates were associated with lower odds of transfer.


CONCLUSIONS
Bed-hold policies were associated with greater continuity of NH care; however, their high cost compared with their small impact on transfer but large impact on increased hospitalizations suggests that they may not be effective.
Intrator
Orna
O
Brown University, Box G-S121-6, Providence, RI 02912, USA. Orna_Intrator@brown.edu
Schleinitz
Mark
M
Grabowski
David C
DC
Zinn
Jacqueline
J
Mor
Vincent
V
D003266:Continuity of Patient Care / Q000191:economics*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008484:Medicaid / Q000191:economics; D015233:Models, Statistical; D009735:Nursing Homes / Q000191:economics / Q000458:organization & administration*; D012959:Socioeconomic Factors; D014481:United States
Public Health Rep. 1988 Mar-Apr;103(2):184-8
3128836
Policy Brief (Cent Home Care Policy Res). 2003 Winter;(16):1-21
15000108
Health Serv Res. 2006 Aug;41(4 Pt 1):1317-36
16899009
Health Aff (Millwood). 2004 Jan-Jun;Suppl Web Exclusives:W4-363-73
15451956
Health Serv Res. 1989 Apr;24(1):105-27
2654084
Health Aff (Millwood). 2003 Mar-Apr;22(2):219-29
12674425
Health Serv Res. 2007 Aug;42(4):1651-71
17610442
Qual Saf Health Care. 2007 Jun;16(3):185-91
17545344
J Am Geriatr Soc. 2004 Oct;52(10):1730-6
15450053
Health Aff (Millwood). 2004 Sep-Oct;23(5):243-52
15371395
Inquiry. 2002 Fall;39(3):258-78
12479538
J Am Geriatr Soc. 1997 Aug;45(8):1002-10
9256855
Med Care. 2000 Jun;38(6):660-9
10843313
Gerontologist. 1995 Apr;35(2):172-8
7750773
Med Care. 1998 Jan;36(1):8-27
9431328
Health Serv Res. 2005 Aug;40(4):1040-55
16033491
Med Care. 2008 Jan;46(1):33-40
18162853
Milbank Q. 2004;82(2):227-56
15225329
J Gerontol Nurs. 2007 Sep;33(9):20-6; quiz 28-9
17899997
J Aging Health. 2005 Apr;17(2):207-38
15750052
Gerontologist. 2005 Aug;45(4):486-95
16051911
J Am Med Dir Assoc. 2004 Mar-Apr;5(2):71-4
14984616
Health Aff (Millwood). 2007 Sep-Oct;26(5):1448-58
17848457
Gerontologist. 1990 Jun;30(3):293-307
2354790
Med Care. 1994 Jul;32(7):668-85
8028403
J Am Geriatr Soc. 1995 Nov;43(11):1237-42
7594157
J Am Med Dir Assoc. 2006 Oct;7(8):486-92
17027625
J Am Geriatr Soc. 2004 Nov;52(11):1826-31
15507058
J Health Econ. 2001 Jul;20(4):549-69
11463188
Am J Law Med. 1986;11(4):405-32
3296747
Health Serv Res. 2004 Oct;39(5):1449-65
15333117
J Am Geriatr Soc. 2000 Feb;48(2):154-63
10682944
Int J Health Care Finance Econ. 2004 Mar;4(1):5-26
15170962
J Am Geriatr Soc. 2004 Mar;52(3):393-8
14962154