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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
R. Tamara Hodlewsky, MA, MS, Dept. of Health Policy and Administration, University of North Carolina at Chapel Hill, 2426 39th Place NW, Washington, DC 20007, (202)333-2420, tamarah@email.unc.edu
This analysis investigates the effect of Medicare's Prospective Payment System (PPS) for skilled nursing facilities on case-mix and quality of care. Since implementation of the PPS system in 1998, a number of providers have blamed the new reimbursement system for serious financial troubles and contend that rates are inadequate to provide a sufficient level of care for some residents. HCFA has responded by temporarily increasing rates, but the true effect of the PPS system on case-mix and quality of care in nursing facilities remains unclear. This study addresses that gap. Minimum Data Set (MDS) assessment data from 1996 through 2000 for the states of Ohio, New York, Kansas, Texas, South Dakota, Mississippi and Maine (Case-Mix Demonstration States) are linked with Online Survey, Certification and Reporting (OSCAR) data and Area Resource File data to form a panel data set. In total, these states represent approximately 333,000 residents in 3,750 nursing facilities at a point in time, with up to 20 quarterly observations per facility. The sample corresponds to approximately 22 percent of facilities nationally. Resident-level data is used to measure changes in outcomes of care, represented by falls, infections, pressure sores, dehydration, and hospitalizations. A difference-in-difference design is used to model the facility-level effects of PPS on outcomes, a design that allows the separation of the effects of PPS from general industry trends. Findings from this investigation could help to guide reimbursement and policy modifications that support the provision of quality nursing home care.
Learning Objectives:
Keywords: Quality of Care, Nursing Homes
Presenting author's disclosure statement:
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.