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. 2011 Sep;49(9):797-802.
doi: 10.1097/MLR.0b013e318223c0ae.

The effect of Medicaid nursing home reimbursement policy on Medicare hospice use in nursing homes

Susan C Miller  1 , Pedro Gozalo, Julie C Lima, Vincent Mor
Affiliations

The effect of Medicaid nursing home reimbursement policy on Medicare hospice use in nursing homes

Susan C Miller et al. Med Care. 2011 Sep.

Abstract

Objective: To understand how changes in Medicaid nursing home (NH) reimbursement policy and rates affect a NH's approach to end-of-life care (ie, its use of hospice).

Methods: This longitudinal study merged US NH decedents' (1999 to 2004) resident assessment data (MDS) with Part A claims data to determine the proportion of a NH's decedents using hospice. Freestanding NHs across the 48 contiguous US states were included. A NH-level analytic file was merged with NH survey (ie, OSCAR) and area resource file data, and with annual data on state Medicaid NH rates, case-mix reimbursement policies, and hospice certificate of need (CON). NH fixed-effect (within) regression analysis examined the effect of changing state policies, controlling for differing time trends in CON and case-mix states and for facility-level and county-level attributes. Models were stratified by urban/rural status.

Results: A $10 increase in the Medicaid rate resulted in a 0.41% [95% confidence interval (CI): 0.275, 0.553] increase in hospice use in urban NHs and a 0.37% decrease (95% CI: -0.676, -0.063) in rural NHs not adjacent to urban areas. There was a nonstatistically significant increase in rural NHs adjacent to urban areas. Introduction of case-mix reimbursement resulted in a 2.14% (95% CI: 1.388, 2.896) increase in hospice use in urban NHs, with comparable increases in rural NHs.

Conclusions: This study supports and extends previous research by showing changes in Medicaid NH reimbursement policies affect a NH's approach to end-of-life care. It also shows how policy changes can have differing effects depending on a NH's urban/rural status.

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Conflict of interest statement

Conflict of Interest: None.

Figures

FIGURE 1
FIGURE 1
Proportion of a state‘s nursing home decedents receiving Medicare hospice in the nursing home.
FIGURE 2
FIGURE 2
The effect of the introduction of Medicaid case-mix reimbursement: Iowa nursing home hospice use (with case-mix introduction in 2001) versus non-Certificate of Need states not introducing case-mix.
See this image and copyright information in PMC

References

    1. Rhoades J, Sommers J, editors. Expenses and Sources of Payment for Nursing Home Residents. Rockville, MD: Agency for Healthcare Research and Quality 2000; 1996. MEPS Research Findings No 13. AHRQ Pub No. 01-0010;
    1. Intrator O, Grabowski DC, Zinn J, et al. Hospitalization of nursing home residents: the effects of states’ Medicaid payment and bed-hold policies. Health Serv Res. 2007;42:1651–1671. - PMC - PubMed
    1. Feng Z, Grabowski DC, Intrator O, et al. The effect of state Medicaid case-mix payment on nursing home resident acuity. Health Serv Res. 2006;41(4 Pt 1):1317–1336. - PMC - PubMed
    1. Feng Z, Grabowski D, Intrator O, et al. Medicaid payment rates, case-mix reimbursement, and nursing home staffing—1996–2004. Med Care. 2008;46:33–40. - PubMed
    1. Mor V, Gruneir A, Feng Z, et al. The effect of state policies on nursing home resident outcomes. J Am Geriatr Soc. 2011;59:3–9. - PMC - PubMed

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