194414 Effect of payer source on hospitalization risks among nursing home residents in New York State

Tuesday, November 10, 2009: 12:45 PM

Shubing Cai , Department of Community Health, Brown University, Providence, RI
Dana B. Mukamel, PhD , Department of Medicine, Health Policy Research Institute, University of California, Irvine, Irvine, CA
Peter Veazie, PhD , Community & Preventive Medicine, University of Rochester, Rochester, NY
Paul Katz, MD , Department of Medicine - Geriatrics, University of Rochester School of Medicine, Rochester, NY
Helena Temkin-Greener, PhD , Department of Community and Preventive Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY
Hospitalizations of nursing home (NH) residents are a marker for quality and efficiency. We examine whether payer type (Medicaid vs. private-pay) and bed-hold status impact NH hospitalizations.

Data include: the 2003 Minimum Data Set (MDS), Medicaid and Medicare claim files, Medicaid cost reports. Individual observations are defined to start from a non-Medicare period. Hospitalization is the dependent, dichotomous variable. Payer status is the main independent variable of interest. Individual-level risk factors are controlled.

Facilities are stratified into 4 groups based on ownership and eligibility for bed-hold payment (determined by occupancy-rate). Base and conditional fixed-effects logit models are fit for these subgroups.

The analytical sample includes 69,307 residents (18 % private-pay & 82% Medicaid) in 564 NY NHs. 28% of residents have >=1 hospitalization during non-Medicare periods. Overall Medicaid residents are more likely to be hospitalized than private-pay residents, and this difference declines significantly after accounting for facility fixed-effects.

Compared with private-pay, Medicaid residents are more likely to be hospitalized in bed-hold-payment eligible facilities (OR=1.34, P<0.001, in for-profits with an average payer-mix level; OR=1.17, P<0.001, in nonprofits). This difference in ORs is significant. Similar effect is detected in bed-hold-payment ineligible nonprofit facilities (OR=1.25, P<0.01), but not in for-profits (OR=1.02, P=0.764) NHs.

Hospitalization risk for Medicaid and private-pay residents, adjusted for individual characteristics, is significantly different. The impact of payer status can be ascribed to both within-facility disparities and to across-facility differences. To reduce hospitalization risks for Medicaid residents, efforts should be focused on reducing both within-facility disparities and across-facility differences.

Learning Objectives:
1) Compare hospitalization risk for Medicaid and private pay nursing home residents. 2) Understand whether payers status impacts both within-facility dispartities and across-facility differences in hospitalization risks.

Keywords: Quality of Care, Nursing Homes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am responsible for the work performed.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.