Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #104154

Lynn Unruh, PhD, RN, Health Services Administration Program, University of Central Florida, HPA-2, Rm 210L, Orlando, FL 32816-2200, (407) 823-4237, lunruh@mail.ucf.edu, Ning J. Zhang, MD, PhD, College of Health and Public Affairs, University of Central Florida, HPA-1, Rm 344, Orlando, FL 32816-2200, and Thomas Wan, PhD, College of Health and Public Affairs, Unversity of Central Florida, HPA-1, Orlando, FL 32816-2200.

Objective: This study assesses the evidence regarding the impact of recent Medicare reimbursement changes on nurse staffing and quality of care in nursing homes.

Design and Methods: Research questions are: 1) Has implementation of a Medicare prospective payment system under the 1997 Balanced Budget Act (BBA) lowered licensed nurse staffing or the quality of care in nursing homes? 2) Has implementation of the 1999 Balanced Budget Reconciliation Act (BBRA) or the 2000 Benefits Improvement and Protection Act (BIPA) counteracted BBA (had a positive effect on staffing or quality)? We utilize data from the On-Line Survey Certification and Reporting System and Area Resource Files from 1997 to 2003. The impacts of the reimbursement changes on licensed nurse hours per resident day and on a quality index were estimated using maximum likelihood procedures. We controlled for facility and market factors and included interaction between payer mix and policy.

Results: We find that the 1997 BBA had a statistically significant negative effect on staffing and quality while the 1999 BBRA and the 2000 BIPA had statistically significant positive effects on staffing and quality. The percentage of Medicaid patients was a strong contributor to lower staffing and quality, but moderated the effects of all three federal policies.

Implications: This study corroborates a prior study on the impact of BBA and BBRA on staffing and quality, and presents new evidence that BIPA had a positive effect on both. Results should be useful to policy makers considering future cuts in Medicare spending for nursing home care.

Learning Objectives: At the conclusion of the session, the participant will be able to

• Describe the nursing home reimbursement changes that occurred with the Balanced Budget Act (BBA) of 1997, the Balanced Budget Reconciliation Act (BBRA) of 1999, and the Benefits Improvement and Protection Act (BIPA) of 2000.
• Summarize the findings of this study regarding the impact of the reimbursement changes on nurse staffing and quality in nursing homes.
• Apply the evidence-based information to guide future decision-making on Medicare and Medicaid spending.

Keywords: Nursing Homes, Medicare

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation