Address correspondence to Orna Intrator, Ph.D., Brown University, Box G-S121-6, Providence, RI 02912; e-mail: Orna_Intrator@brown.edu. Mark Schleinitz, M.D., M.S., Assistant Professor of Medicine, is with Brown University, Rhode Island Hospital, DGIM, Providence, RI. David C. Grabowski, Ph.D., is with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Jacqueline Zinn, Ph.D., is with the Fox School of Business and Management, Temple University, Philadelphia, PA. Vincent Mor is with the Brown University Department of Community Health, Providence, RI.
Maintaining Continuity of Care for Nursing Home Residents: Effect of States' Medicaid Bed-Hold Policies and Reimbursement Rates
Article first published online: 8 SEP 2008
© Health Research and Educational Trust
Health Services Research
Volume 44, Issue 1, pages 33–55, February 2009
How to Cite
Intrator, O., Schleinitz, M., Grabowski, D. C., Zinn, J. and Mor, V. (2009), Maintaining Continuity of Care for Nursing Home Residents: Effect of States' Medicaid Bed-Hold Policies and Reimbursement Rates. Health Services Research, 44: 33–55. doi: 10.1111/j.1475-6773.2008.00898.x
- Issue published online: 15 JAN 2009
- Article first published online: 8 SEP 2008
- multilevel models;
- Minimum Data Set (MDS);
Objective. Recent public concern in response to states' intended repeal of Medicaid bed-hold policies and report of their association with higher hospitalization rates prompts examination of these policies in ensuring continuity of care within the broader context of Medicaid policies.
Data Sources/Study Design. Minimum Data Set assessments of long-stay nursing home residents in April–June 2000 linked to Medicare claims enabled tracking residents' hospitalizations during the ensuing 5 months and determining hospital discharge destination. Multinomial multilevel models estimated the effect of state policies on discharge destination controlling for resident, hospitalization, nursing home, and market characteristics.
Results. Among 77,955 hospitalizations, 5,797 (7.4 percent) were not discharged back to the baseline nursing home. Bed-hold policies were associated with lower odds of transfer to another nursing home (AOR=0.55, 95 percent CI 0.52–0.58) and higher odds of hospitalization (AOR=1.36), translating to 9.5 fewer nursing home transfers and 77.9 more hospitalizations per 1,000 residents annually, and costing Medicaid programs about $201,311. Higher Medicaid reimbursement rates were associated with lower odds of transfer.
Conclusions. Bed-hold policies were associated with greater continuity of NH care; however, their high cost compared with their small impact on transfer but large impact on increased hospitalizations suggests that they may not be effective.