In order for Medicare to reimburse post-acute care in a skilled nursing facility (SNF), Medicare beneficiaries must have a 3-day hospital stay. Some hospital stays, however, are not counted as hospital stays; rather, they may be defined as “observation status” care that do not merit an inpatient admission. Patients may stay overnight at the hospital [...]
Read the rest of this entry »Archive for the 'Nursing Homes' Category
Long Term Care in the 13th Century
There have been a number of recent efforts to finance long-term care for the elderly. The health reform law, as amended by the Health Care and Education Reconciliation Act of 2010, created a national, voluntary insurance program for purchasing community living services and supports known as the Community Living Assistance Services and Supports program (CLASS [...]
Read the rest of this entry »Medicare pays $5.1 billion for Poor Quality Skilled Nursing Facility Care
The Office of the Inspector General found substandard care at a number of skilled nursing facilities. Their investigation found the following: For 37 percent of stays, SNFs did not develop care plans that met requirements or did not provide services in accordance with care plans. For 31 percent of stays, SNFs did not meet discharge [...]
Read the rest of this entry »The Effect of Medicaid P4P on Nursing Home Quality
Over 10 million Americans need long-term services and supports to assist them in life’s daily activities. Of these, 1.6 million reside in a nursing home. Nursing home care, however, is expensive ($74,800 per year) and and quality is highly variable. To improve the quality of care, many states have begun adopting pay-for-performance (P4P) programs for nursing homes. Between [...]
Read the rest of this entry »Free-Market Healthcare? Nursing Home Payment and Financing
Although many people believe that the U.S. healthcare system is a free-market, that is far from the case. Consider nursing homes. Two-thirds of patient spending on nursing home care comes from public sources. Not only do public funds pay for the variable cost of running nursing homes, but the federal government also provides low-interest [...]
Read the rest of this entry »Effect of Nursing Home Ownership on Quality
Do non-profit nursing home provide better quality than for-profit nursing homes? Generally, for-profit nursing homes appear to have better quality measures, but this could be due to the fact that non-profit nursing homes act as a safety net, whereas non-profit nursing homes treat sicker patients. Today, I look at Grabowski et al. (2012)‘s attempt to [...]
Read the rest of this entry »Nursing Home Quality
Typically, Nursing Home quality is measured using metrics from Nursing Home Compare. These metrics are calculated based on survey and certification processes and resident assessments from from the Minimum Data Set (MDS). These, however, are not the only quality metrics one can use. For instance, one can use consumer complaints as a measure of quality [...]
Read the rest of this entry »Medicare Reimbursement for Outpatient Therapy
Today I review Medicare’s approach for paying for outpatient therapy visits. The content draws largely from CMS and MedPAC sources. What is outpatient therapy Outpatient therapy includes physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services. Who can provide outpatient therapy? Institutional Facilities Hospitals Skilled nursing facilities (SNF) Comprehensive outpatient rehabilitation facilities (CORF) [...]
Read the rest of this entry »Shrinkage Estimators and Composite Quality Scores
Shrinkage estimators (such as the James-Stein estimator) are well-known in the economics literature and have a number of applications. A recent paper by Shwartz et al. 2012 demonstrates how one could apply shrinkage estimators to measure nursing home quality. “A challenge when examining individual QIs across a range of facilities is that sample sizes are [...]
Read the rest of this entry »Does Public Reporting Affect Patient Behavior?
A number of studies have already examined this question. Baker et al. (2003) examined the effectiveness of a public reporting effort in hospitals in Ohio, finding little relationship between a hospital’s report card ranking and changes in its market share. Cutler et al. (2004) examined the effects of reporting quality information about cardiac surgery on [...]
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