title: Are dual eligibles admitted to poorer quality skilled nursing facilities?
abstract: BACKGROUND
  Dual eligibles, persons who qualify for both Medicare and Medicaid coverage, often receive poorer quality care relative to other Medicare beneficiaries.
  
  
  OBJECTIVE
  To determine whether dual eligibles are discharged to lower quality post-acute skilled nursing facilities (SNFs) compared with Medicare-only beneficiaries.
  
  
  METHODS
  Following the random utility maximization model, we specified a discharge function using a conditional logit model and tested how this discharge rule varied by dual-eligibility status.
  
  
  METHODS
  A total of 692,875 Medicare fee-for-service patients (22% duals) who were discharged for Medicare paid SNF care between July 2004 and June 2005.
  
  
  METHODS
  Medicare enrollment and the Medicaid Analytic Extract files were used to determine dual eligibility. The proportion of Medicaid patients and nursing staff characteristics provided measures of SNF quality.
  
  
  RESULTS
  Duals are more likely to be discharged to SNFs with a higher share of Medicaid patients and fewer nurses. These results are robust to estimation with an alternative subsample of patients based on primary diagnoses, propensity of being dual eligible, and likelihood of remaining in the nursing home.
  
  
  CONCLUSIONS
  Disparities exist in access to quality SNF care for duals. Strategies to improve discharge planning processes are required to redirect patients to higher quality providers, regardless of Medicaid eligibility.
authors.affiliation: Department of Health Services Policy and Practice, Brown University, Providence, RI.
authors.forename: Momotazur
authors.initials: M
authors.lastname: Rahman
authors.forename: David C
authors.initials: DC
authors.lastname: Grabowski
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Gozalo
authors.forename: Kali S
authors.initials: KS
authors.lastname: Thomas
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D063026:Dual Medicare Medicaid Eligibility; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D010351:Patient Discharge; D011787:Quality of Health Care; D012866:Skilled Nursing Facilities / Q000592:standards*; D014481:United States
keywords: Health economics; quality of care; skilled nursing facility care