Dual Eligibility, Selection of Skilled Nursing Facility, and Length of Medicare Paid Postacute Stay.
Medicare and Medicaid dual-eligible beneficiaries use more medical care and experience worse health outcomes than Medicare-only beneficiaries. This article points to a possible inefficiency in the skilled nursing facility (SNF) admission process, specifically that patients and SNFs are partially matched based on dual-eligibility status, and investigates its influence on patients' SNF length of stay. Using a set of fee-for-service beneficiaries newly admitted for Medicare-paid SNF care, we document two findings: (1) compared with Medicare-only patients, dual-eligibles are more likely to be discharged to SNFs with low nurse-to-patient ratios and (2) dual-eligibles are more likely to become long-stay nursing home residents than Medicare-only beneficiaries if treated in SNFs with low nurse-to-patient ratios. We conclude that changes in the current SNF care referral process have the potential to reduce excess SNF utilization by dual-eligible beneficiaries and could help reduce spending by both Medicare and Medicaid.
Brown University, Providence, RI, USA momotazur_rahman@brown.edu.
Momotazur
M
Rahman
Brown University, Providence, RI, USA.
Pedro
P
Gozalo
Brown University, Providence, RI, USA.
Denise
D
Tyler
Harvard University, Boston, MA, USA.
David C
DC
Grabowski
Brown University, Providence, RI, USA.
Amal
A
Trivedi
Brown University, Providence, RI, USA.
Vincent
V
Mor
D000368:Aged; D063026:Dual Medicare Medicaid Eligibility; D004608:Eligibility Determination; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D014481:United States
care utilization; dual eligibility; skilled nursing facility care