Online Program

State policies and nursing home investment in internal and external palliative care

Tuesday, November 5, 2013 : 1:00 p.m. - 1:15 p.m.

Susan Miller, PhD, School of Public Health, Brown University, Warwick, RI
Kali Thomas, PhD, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI
Objective: To understand how Medicaid reimbursement policies may be associated with nursing home (NH) investment in palliative care (PC) Methods: In 2009/10 we surveyed a nationally representative sample of NH Directors of Nursing (DoNs) at 4,149 NHs. Contact was achieved with 3,520 DoNs and 61.6% responded. The survey included questions on PC knowledge and practices from the validated NH “PC Survey.” Based on scored responses, a variable representing whether a NH had made a substantial investment in “internal PC” (score above the median) was created. NH investment in (external) PC was represented by the proportion of days NH residents spend on hospice, and was obtained from the LTCFocUS internet site. Multivariate linear and logistic regression analyses were conducted. Controlling for hospice certificate of need, examined were the presence of Medicaid casemix reimbursement (with or without exclusion of hospice residents in its rate calculation) and NH pass-through payment (hospices receive Medicaid NH per diem payment and “pass-through” to NHs). Results: In states where Medicaid NH per diems for hospice residents are paid directly to NHs, NHs had a significantly lower likelihood of making a substantial investment in internal PC (AOR 0.44, CI 0.24, 0.83), but had a greater external investment (i.e., greater hospice use; coefficient 1.24, SE 0.42). In this cross-sectional analysis no significant association was observed between casemix policy and PC investment. Implications: Findings suggest that NHs are responsive to payment policies. Considering this, incorporating PC performance measures into Medicaid NH pay-for-performance systems could potentially increase NH investment in PC.

Learning Areas:

Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Describe the variation in Medicaid nursing home reimbursement policies across U.S. states, and in particular, policies relating to residents who elect to receive Medicare hospice. Describe how Medicaid reimbursement policies are associated with a nursing home’s internal and external palliative care investments.

Keyword(s): End-of-Life Care, Policy/Policy Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been studying hospice care in nursing homes for over 15 years and much of my research has focused on policy.
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.