title: The Impact of Nursing Home Pay-for-Performance on Quality and Medicare Spending: Results from the Nursing Home Value-Based Purchasing Demonstration.
abstract: To evaluate the impact of the Nursing Home Value-Based Purchasing demonstration on quality of care and Medicare spending.
  
  
  
  Administrative and qualitative data from Arizona, New York, and Wisconsin nursing homes over the base-year (2008-2009) and 3-year (2009-2012) demonstration period.
  
  
  
  Nursing homes were randomized to the intervention in New York, while the comparison facilities were constructed via propensity score matching in Arizona and Wisconsin. We used a difference-in-difference analysis to compare outcomes across the base-year relative to outcomes in each of the three demonstration years. To provide context and assist with interpretation of results, we also interviewed staff members at participating facilities.
  
  
  
  Medicare savings were observed in Arizona in the first year only and Wisconsin for the first 2 years; no savings were observed in New York. The demonstration did not systematically impact any of the quality measures. Discussions with nursing home administrators suggested that facilities made few, if any, changes in response to the demonstration, leading us to conclude that the observed savings likely reflected regression to the mean rather than true savings.
  
  
  
  The Federal nursing home pay-for-performance demonstration had little impact on quality or Medicare spending.
authors: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors: David C
authors: DC
authors: Grabowski
authors: Department of Health Policy, Vanderbilt University, Nashville, TN.
authors: David G
authors: DG
authors: Stevenson
authors: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors: Daryl J
authors: DJ
authors: Caudry
authors: The Department of Biomedical Data Science and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH.
authors: A James
authors: AJ
authors: O'Malley
authors: L&M Policy Research, LLC, Washington, DC.
authors: Lisa H
authors: LH
authors: Green
authors: L&M Policy Research, LLC, Washington, DC.
authors: Julia A
authors: JA
authors: Doherty
authors: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors: Richard G
authors: RG
authors: Frank
mesh_terms: D017046:Cost Savings; D006801:Humans; D006278:Medicare / Q000191:economics*; D009735:Nursing Homes / Q000191:economics*; D036301:Qualitative Research; D011787:Quality of Health Care; D012052:Reimbursement, Incentive; D014481:United States; D062505:Value-Based Purchasing
keywords: Nursing homes; pay-for-performance; quality of care