Nurse Staffing Levels and Medicaid Reimbursement Rates in Nursing Facilities

Authors

  • Charlene Harrington,

    1. Department of Social & Behavioral Sciences, University of California, 3333 California Street, Suite 455, San Francisco, CA 94118,
    Search for more papers by this author
    • Address correspondence to Charlene Harrington, Ph.D., R.N., Department of Social & Behavioral Sciences, University of California, 3333 California Street, Suite 455, San Francisco, CA 94118. James H. Swan, Ph.D., is with the Department of Applied Gerontology, School of Community Service, Denton, TX. Helen Carrillo, M.S., is with the Department of Social & Behavioral Sciences, University of California, San Francisco, CA.

  • James H. Swan,

    1. Department of Applied Gerontology, School of Community Service, Denton, TX,
    Search for more papers by this author
  • Helen Carrillo

    1. Department of Social & Behavioral Sciences, University of California, San Francisco, CA
    Search for more papers by this author

Abstract

Objective. To examine the relationship between nursing staffing levels in U.S. nursing homes and state Medicaid reimbursement rates.

Data Sources. Facility staffing, characteristics, and case-mix data were from the federal On-Line Survey Certification and Reporting (OSCAR) system and other data were from public sources.

Study Design. Ordinary least squares and two-stage least squares regression analyses were used to separately examine the relationship between registered nurse (RN) and total nursing hours in all U.S. nursing homes in 2002, with two endogenous variables: Medicaid reimbursement rates and resident case mix.

Principal Findings. RN hours and total nursing hours were endogenous with Medicaid reimbursement rates and resident case mix. As expected, Medicaid nursing home reimbursement rates were positively related to both RN and total nursing hours. Resident case mix was a positive predictor of RN hours and a negative predictor of total nursing hours. Higher state minimum RN staffing standards was a positive predictor of RN and total nursing hours while for-profit facilities and the percent of Medicaid residents were negative predictors.

Conclusions. To increase staffing levels, average Medicaid reimbursement rates would need to be substantially increased while higher state minimum RN staffing standards is a stronger positive predictor of RN and total nursing hours.

Ancillary