title: The Impact of Green House Adoption on Medicare Spending and Utilization.
abstract: OBJECTIVE
  To evaluate the impact of the Green House (GH) model of nursing home care on Medicare acute hospital, other hospital, skilled nursing facility, and hospice spending and utilization.
  
  
  METHODS
  Medicare claims and enrollment data from 2005 through 2010 merged with resident-level minimum data set (MDS) assessments.
  
  
  METHODS
  Using a difference-in-differences framework, we compared Medicare Part A and hospice expenditures and utilization in 15 nursing homes that adopted the GH model relative to changes over the same time period in 223 matched nonadopting nursing homes. We applied the same method for residents of GH homes and for residents of "legacy" homes, the original nursing homes that stay open alongside the GH home(s).
  
  
  RESULTS
  The adoption of GH had no detectable impact on Medicare Part A (plus hospice) spending and utilization across all residents living in the nursing home. When we analyzed residents living in GH homes and legacy units separately, however, we found that the adoption of the GH model reduced overall annual Medicare Part A spending by $7,746 per resident, although this appeared to be partially offset by an increase in spending in legacy homes.
  
  
  CONCLUSIONS
  To the extent that the GH model reduces Medicare spending, adopting nursing homes do not receive any of the related Medicare savings under traditional payment mechanisms. New approaches that are currently being developed and piloted, which better align financial incentives for providers and payers, could incentivize greater adoption of the GH model.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: David C
authors.initials: DC
authors.lastname: Grabowski
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Afendulis
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Daryl J
authors.initials: DJ
authors.lastname: Caudry
authors.affiliation: Geisel School of Medicine, The Dartmouth Institute, Dartmouth College, Lebanon, NH.
authors.forename: A James
authors.initials: AJ
authors.lastname: O'Malley
authors.affiliation: The Pennsylvania State University, University Park, PA.
authors.forename: Peter
authors.initials: P
authors.lastname: Kemper
mesh_terms: D017051:Hospice Care / Q000191:economics; D006801:Humans; D007345:Insurance Claim Review; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000191:economics* / Q000458:organization & administration; D018802:Patient-Centered Care / Q000379:methods*; D014481:United States
keywords: Green House nursing home; Medicare spending; Nursing homes; culture change