Case-mix acuity has been increasing nationally in nursing facilities in the 1990s; and reimbursement systems have increasingly been based in part on measurements of case mix. This paper reports on a model of nursing facility case mix, explaining continuing-care case mix (excluding admission assessments) based on various facility and local (county-level) characteristics, particularly the ratio of local residential care beds to nursing home beds and the size of the community. Data on 1,483 facilities in five states (Kansas, Maine, Mississippi, South Dakota, and Ohio) in 1995 were obtained from HCFA's OSCAR data set, state MDS + telephone surveys of state nursing facility policies and supply, and the Area Resource File. All five states use case-mix measures in their Medicaid nursing facility reimbursement methods. OLS regression analysis was done in SAS, including separate estimation for communities in four size classes. Medicaid shares of residents tended to case-mix acuity of residents, especially in larger communities. Contrary to hypothesis, Medicare shares of residents showed similar, though weaker, patterns. Effects of the proportions of residential care beds in a local market varied with size of community, and did not generally support hypotheses of increasing case mix. Other predictors included facility-based measures, particularly certification as a SNF, which predicted higher case mix. Strong interstate differences persisted after control for the explanatory factors. These findings have implications for understanding nursing facility factors that strongly influence payment for and access to, as well as costs and quality of, nursing facility care.
Learning Objectives: Participants should be able to: recognize factors important to nursing facility care; identify factors, particularly market factors, that explain the nursing facility case mix, and consider implications for facility reimbursement and access, as well as costs and quality
Keywords: Long-Term Care, Medicaid
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.