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Effect of State Medicaid Reimbursement Rates on Hospitalizations from Nursing Homes

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  • Supported, in part, by grants to Brown University: National Institute on Aging Grants AG 11624 and AG 20557, Agency for Healthcare Research and Quality Grant HS09723-01, and a grant from the Retirement Research Foundation, “Decisions About Death in Long-Term Care: Development and Dissemination of Guidelines to Ease the Death of a Resident in the Nursing Home,” Mathy Mezey, Principal Investigator, the Hartford Institute for Geriatric Nursing, New York University Division of Nursing. A preliminary version of this paper (Mor V, Intrator O. Impact of State Medicaid Payment Rates on Hospitalization of Nursing Home Residents. Gerontologist 2001;41:120) was presented as part of a symposium titled “Doing More with Less? Nursing Home Care in an Era of Diminished Resources” at the annual meeting of the Gerontological Society of America in Chicago, IL, November 2001. It appears only as a title in the conference abstract book.

Address correspondence to Orna Intrator, PhD, Center for Gerontology and Health Care Research, Brown University Box G-ST2, Providence, RI 02912. E-mail: orna_intrator@brown.edu

Abstract

Objectives: To estimate the effect of state Medicaid nursing home reimbursement rates on hospitalizations of nursing home residents.

Design: Cross-sectional sample of nongovernment-owned nursing homes with 25 beds or more in one Metropolitan Statistical Area in each of 10 states in 1993, with 6 months follow-up on mortality and hospitalizations.

Setting: Two hundred fifty-three nursing homes.

Participants: Eight to 16 randomly selected residents from each facility, totaling 2,080.

Measurements: Minimum Data Set assessments conducted by research nurses at baseline. A three-category 6-month outcome was defined as (1) any hospitalization; for those not hospitalized, (2) death versus (3) alive in the facility.

Results: Using multinomial logistic regression, adjusted to survey design, controlling for resident and facility characteristics, a $10 increase in 1993 Medicaid reimbursement rate above the mean rate of approximately $75 resulted in a 9% reduction in a resident's risk of hospitalization (P<.05).

Conclusion: State Medicaid reimbursement rates appear to affect clinical decisions regarding the need for hospital admission and thresholds for nursing home use. The findings from this study reemphasize the importance of properly aligning state Medicaid and federal Medicare long-term care policies because, currently, states have no incentive to increase reimbursement rates to avoid hospitalization.

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