Medicaid bed-hold policy and Medicare skilled nursing facility rehospitalizations.
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.
Grabowski
David C
DC
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899, USA. grabowski@med.harvard.edu
Feng
Zhanlian
Z
Intrator
Orna
O
Mor
Vincent
V
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
Gerontologist. 2003 Apr;43(2):175-91
12677075
J Health Econ. 1993 Oct;12(3):349-59
10129842
J Health Econ. 1993 Oct;12(3):259-80
10171727
Milbank Q. 2004;82(2):227-56
15225329
Q Rev Econ Bus. 1989 Summer;29(2):27-40
10303971
J Am Geriatr Soc. 2004 Oct;52(10):1730-6
15450053
Rev Econ Stat. 2008 Nov 1;90(4):754-764
20463859
N Engl J Med. 2009 Apr 2;360(14):1418-28
19339721
Med Care Res Rev. 1996 Jun;53(2):123-48
10157708
J Am Geriatr Soc. 2000 Feb;48(2):154-63
10682944
Milbank Q. 2007 Dec;85(4):579-610
18070331
Med Care. 2004 Oct;42(10):985-91
15377931
Health Serv Res. 2009 Feb;44(1):33-55
18783452
Health Aff (Millwood). 2004 Jan-Jun;Suppl Web Exclusives:W4-363-73
15451956
Health Aff (Millwood). 2007 Nov-Dec;26(6):1753-61
17978395
Health Serv Res. 2007 Aug;42(4):1651-71
17610442
Inquiry. 1987 Summer;24(2):157-72
2954912
Med Care. 1999 Mar;37(3):228-37
10098567
Health Aff (Millwood). 2010 Jan-Feb;29(1):57-64
20048361
J Am Geriatr Soc. 1997 Aug;45(8):1011-6
9256856
J Aging Health. 2005 Apr;17(2):207-38
15750052
Med Care. 2006 Mar;44(3):270-6
16501399
EBRI Issue Brief. 1996 Dec;(180):1-13
10163864
Gerontologist. 2004 Feb;44(1):13-23
14978317
J Health Econ. 2007 May 1;26(3):560-77
17095111
J Am Geriatr Soc. 1997 Aug;45(8):1002-10
9256855
Int J Health Care Finance Econ. 2006 Sep;6(3):173-89
17016764
Ment Health Serv Res. 1999 Sep;1(3):185-96
11258741
Vital Health Stat 13. 2002 Jun;(152):1-116
12071118
Gerontologist. 1990 Jun;30(3):293-307
2354790
Med Care. 1994 Jul;32(7):668-85
8028403
Med Care Res Rev. 2008 Aug;65(4):514-27
18369236
Gerontologist. 1995 Feb;35(1):35-43
7890201
J Am Geriatr Soc. 2004 Mar;52(3):393-8
14962154