title: Medicaid bed-hold policy and Medicare skilled nursing facility rehospitalizations.
abstract: OBJECTIVE
  To analyze the effect of states' Medicaid bed-hold policies on the 30-day rehospitalization of Medicare postacute skilled nursing facility (SNF) residents.
  
  
  METHODS
  Minimum data set assessments were merged with Medicare claims and eligibility files for all first-time SNF admissions (N = 3,322,088) over the period 2000 through 2005; states' Medicaid bed-hold policies were obtained via survey.
  
  
  METHODS
  Regression specification incorporating facility fixed effects to examine changes in Medicaid bed-hold policies on the likelihood of a 30-day SNF rehospitalization.
  
  
  RESULTS
  Using a continuous measure of bed-hold generosity, state Medicaid bed-hold was positively related to Medicare SNF rehospitalization. Specifically, the introduction of a bed-hold policy with average generosity increases Medicare rehospitalizations by 1.8 percent, representing roughly 12,000 SNF rehospitalizations at a cost to Medicare of approximately U.S.$100 million over our study period.
  
  
  CONCLUSIONS
  Although facilities do not receive a Medicaid bed-hold payment for Medicare SNF stays, we found that the adoption of more generous policies led to greater SNF rehospitalizations. This type of spillover is largely ignored in current discussions of Medicare payment reforms such as bundled payment. Neither Medicare nor Medicaid has an incentive to internalize the risks and benefits of its actions as they affect the other.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899, USA. grabowski@med.harvard.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Grabowski
authors.forename: Zhanlian
authors.initials: Z
authors.lastname: Feng
authors.forename: Orna
authors.initials: O
authors.lastname: Intrator
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000367:Age Factors; D005006:Ethnicity; D006302:Health Services Research; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008484:Medicaid; D006278:Medicare; D010359:Patient Readmission / Q000706:statistics & numerical data*; D057766:Policy; D012051:Reimbursement Mechanisms; D012737:Sex Factors; D012866:Skilled Nursing Facilities / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States
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