National Healthcare Quality and Disparities Report
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- Caregiving (1)
- Dementia (1)
- Elderly (4)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 13 of 13 Research Studies DisplayedSharma H, Xu L
Use of intergovernmental transfers-based Medicaid supplemental payments to boost nursing home finances: evidence from Indiana nursing homes.
The objective of this study was to estimate the effect of participation in the intergovernmental transfers-based Medicaid supplemental payment program on nursing home revenue and expenditures. Data was taken from all Medicare and Medicaid-certified nursing homes in Indiana from 2009-17. The findings indicated that nursing homes owned or operated by nonstate governmental organizations received a fraction of the total supplemental payments on average, but the authors observed increased payments in later years. Participating nursing homes did not increase clinical expenses. The authors concluded that these findings raised questions regarding the transparency of financing arrangements between nonstate governmental organizations and nursing homes and the need to link supplemental payments to clinical expenses.
AHRQ-funded; HS027235.
Citation: Sharma H, Xu L .
Use of intergovernmental transfers-based Medicaid supplemental payments to boost nursing home finances: evidence from Indiana nursing homes.
Med Care 2023 Aug; 61(8):546-53. doi: 10.1097/mlr.0000000000001875..
Keywords: Nursing Homes, Medicare, Medicaid, Healthcare Costs
Kalata S, Howard R, Diaz A
Association of skilled nursing facility ownership by health care networks with utilization and spending.
The objective of this cross-sectional study was to determine the association of vertical integration of skilled nursing facilities (SNFs) within hospital networks with SNF utilization, readmissions, and spending. Claims data from Medicare beneficiaries aged 66 to 99 who had undergone elective hip replacement in nonfederal acute care hospitals during the study period was analyzed. Results showed that vertical SNF integration was associated with a higher rate of SNF utilization and a lower 30-day readmission rate; in spite of higher utilization, 30-day episode payments were slightly lower. Adjusted readmission rates were especially low for patients who were not sent to an SNF but were significantly higher for patients with a length of stay of less than 5 days. The authors concluded these findings support the value of integrating SNFs into hospital networks, but there is room for improvement in postoperative care early in the SNF patients’ stay.
AHRQ-funded; HS028606.
Citation: Kalata S, Howard R, Diaz A .
Association of skilled nursing facility ownership by health care networks with utilization and spending.
JAMA Netw Open 2023 Feb; 6(2):e230140. doi: 10.1001/jamanetworkopen.2023.0140..
Keywords: Nursing Homes, Healthcare Utilization, Healthcare Costs, Medicare
Hass Z, Woodhouse M, Arling G
Using a semi-Markov Model to estimate Medicaid cost savings due to Minnesota's Return to Community Initiative.
This simulation estimated the level of uncertainty for Medicaid cost savings due to Minnesota’s Return to Community Initiative (RTCI). This statewide program assists private paying nursing home residents with discharge to the community. Prior analysis estimated that approximately 1 in 9 residents targeted for transition by the program would not have returned to the community without the RTCI. Data from 30,234 private pay nursing home residents admitted during 2011 to 378 facilities and followed for 4 years postadmission for outcomes and time to event was used. The simulation was run 1000 times with and without the RTCI impact to estimate change in Medicaid nursing home days. Program savings was estimated at $4.1 million per year over a 4-year accumulation period. This is a modest Medicaid cost savings more than the annual program budget of $3.5 million.
AHRQ-funded; HS020224.
Citation: Hass Z, Woodhouse M, Arling G .
Using a semi-Markov Model to estimate Medicaid cost savings due to Minnesota's Return to Community Initiative.
J Am Med Dir Assoc 2021 Mar;22(3):642-47.e1. doi: 10.1016/j.jamda.2020.07.016..
Keywords: Medicaid, Nursing Homes, Healthcare Costs, Transitions of Care
Kennedy G, Lewis VA, Kundu S
Kennedy G, Lewis VA, Kundu S, Mousqués J, Colla CH. Accountable care organizations and post-acute care: a focus on preferred SNF networks.
This study examined the relationship between accountable care organizations (ACOs) and skilled nursing facilities (SNFs) for patients who are discharged from a hospital into a SNF. A mixed-method design was used and survey data was examined from 366 respondents to the National Survey of ACOs along with 16 semi-structured interviews with ACOs who performed well on cost and quality measures. Over half of ACOs had no formal relationship with SNFs; however the majority of ACO interviewees had preferred SNF networks. These preferred networks are beginning to transform the ACO post-acute care landscape.
AHRQ-funded; HS024075.
Citation: Kennedy G, Lewis VA, Kundu S .
Kennedy G, Lewis VA, Kundu S, Mousqués J, Colla CH. Accountable care organizations and post-acute care: a focus on preferred SNF networks.
Med Care Res Rev 2020 Aug;77(4):312-23. doi: 10.1177/1077558718781117..
Keywords: Nursing Homes, Healthcare Costs, Payment
He D, McHenry P, Mellor JM
Do financial incentives matter? Effects of Medicare price shocks on skilled nursing facility care.
The authors provided new evidence on how Medicare payment changes affect the amount of skilled nursing facility (SNF) care provided to Medicare patients. They found that increases in Medicare payment rates to SNFs increased the total number of Medicare resident days at SNFs. Further, the effects were asymmetric; although Medicare payment increases affected Medicare days, payment decreases did not. They conclude that their results have important implications for policies that alter the Medicare base payment rates to SNFs and other health care providers.
AHRQ-funded; HS025529.
Citation: He D, McHenry P, Mellor JM .
Do financial incentives matter? Effects of Medicare price shocks on skilled nursing facility care.
Health Econ 2020 Jun;29(6):655-70. doi: 10.1002/hec.4009..
Keywords: Medicare, Nursing Homes, Elderly, Payment, Healthcare Costs
Werner RM, Konetzka RT, Qi M
The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs.
The objective of this study was to investigate the impact of Medicare's skilled nursing facility (SNF) copayment policy, with a large increase in the daily copayment rate on the 20th day of a benefit period, on length of stay, patient outcomes, and costs. The investigators concluded that Medicare's SNF copayment policy was associated with shorter lengths of stay and worse patient outcomes, suggesting the copayment policy had unintended and negative effects on patient outcomes.
AHRQ-funded; HS024266.
Citation: Werner RM, Konetzka RT, Qi M .
The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs.
Health Serv Res 2019 Dec;54(6):1184-92. doi: 10.1111/1475-6773.13227..
Keywords: Medicare, Nursing Homes, Payment, Long-Term Care, Healthcare Costs, Elderly, Hospitalization, Hospital Discharge
Weech-Maldonado R, Pradhan R, Dayama N
Nursing home quality and financial performance: is there a business case for quality?
This study examined the relationship between nursing home quality and financial performance. The study found that the operating margin was lower in nursing homes that: reported higher LPN hours per resident day and higher RN skill mix (structure); higher use of catheters, lower pressure ulcer prevention, and lower restorative ambulation (process); and more residents with contractures, pressure ulcers, hospitalizations and health deficiencies (outcomes). The results suggested that there was a business case for quality, whereas nursing homes that have better processes and outcomes of care perform better financially.
AHRQ-funded; HS023345; HS013852.
Citation: Weech-Maldonado R, Pradhan R, Dayama N .
Nursing home quality and financial performance: is there a business case for quality?
Inquiry 2019 Jan-Dec;56:46958018825191. doi: 10.1177/0046958018825191..
Keywords: Nursing Homes, Quality of Care, Healthcare Costs
Goldberg EM, Trivedi AN, Mor V
Favorable risk selection in Medicare Advantage: trends in mortality and plan exits among nursing home beneficiaries.
This study uses mortality differences, nursing home utilization, and switch rates to assess whether the 2003 Medicare Modernization Act (MMA) successfully decreased risk selection from 2000 to 2012. The study found no decrease in the mortality difference or adjusted difference in nursing home use between plan beneficiaries pre- and post the MMA.
AHRQ-funded; HS000011.
Citation: Goldberg EM, Trivedi AN, Mor V .
Favorable risk selection in Medicare Advantage: trends in mortality and plan exits among nursing home beneficiaries.
Med Care Res Rev 2017 Dec;74(6):736-49. doi: 10.1177/1077558716662565..
Keywords: Healthcare Costs, Medicare, Mortality, Nursing Homes
Jutkowitz E, Kuntz KM, Dowd B
Effects of cognition, function, and behavioral and psychological symptoms on out-of-pocket medical and nursing home expenditures and time spent caregiving for persons with dementia.
This study used cross-sectional data (Aging, Demographics, and Memory Study) to estimate probabilities of experiencing outcomes by clinical features. It found that no clinical feature predicted the probability of having out-of-pocket medical expenditures. For those with medical expenditures, higher cognition and poorer function were associated with more spending.
AHRQ-funded; HS024165.
Citation: Jutkowitz E, Kuntz KM, Dowd B .
Effects of cognition, function, and behavioral and psychological symptoms on out-of-pocket medical and nursing home expenditures and time spent caregiving for persons with dementia.
Alzheimers Dement 2017 Jul;13(7):801-09. doi: 10.1016/j.jalz.2016.12.011.
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Keywords: Caregiving, Dementia, Elderly, Healthcare Costs, Long-Term Care, Neurological Disorders, Nursing Homes
Rahman M, Keohane L, Trivedi AN
High-cost patients had substantial rates of leaving Medicare Advantage and joining traditional Medicare.
The investigators examined the rates at which participants who used three high-cost services switched between Medicare Advantage and traditional Medicare. They found that the switching rate from 2010 to 2011 away from Medicare Advantage and to traditional Medicare exceeded the switching rate in the opposite direction for participants who used long-term nursing home care, short-term nursing home care, and home health care. These results were magnified among people who were enrolled in both Medicare and Medicaid.
AHRQ-funded; HS000011.
Citation: Rahman M, Keohane L, Trivedi AN .
High-cost patients had substantial rates of leaving Medicare Advantage and joining traditional Medicare.
Health Aff 2015 Oct;34(10):1675-81. doi: 10.1377/hlthaff.2015.0272.
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Keywords: Healthcare Costs, Home Healthcare, Long-Term Care, Medicare, Nursing Homes
Keohane LM, Grebla RC, Mor V
Medicare Advantage members' expected out-of-pocket spending for inpatient and skilled nursing facility services.
In 2011, new federal regulations restricted inpatient and skilled nursing facility cost sharing and mandated limits on out-of-pocket spending in Medicare Advantage (MA) plans. The authors found that some MA beneficiaries may still have difficulty affording acute and postacute care despite greater regulation of cost sharing.
AHRQ-funded; HS000011.
Citation: Keohane LM, Grebla RC, Mor V .
Medicare Advantage members' expected out-of-pocket spending for inpatient and skilled nursing facility services.
Health Aff 2015 Jun;34(6):1019-27. doi: 10.1377/hlthaff.2014.1146.
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Keywords: Healthcare Costs, Hospitalization, Policy, Medicare, Nursing Homes
van Hasselt M, McCall N, Keyes V
Total cost of care lower among Medicare fee-for-service beneficiaries receiving care from patient-centered medical homes.
The authors compared health care utilization and payments between NCQA-recognized patient-centered medical home (PCMH) practices and practices without such recognition. They found that, relative to the comparison group, total Medicare payments, acute care payments, and the number of emergency room visits declined after practices received NCQA PCMH recognition. The decline was larger for practices with sicker than average patients, primary care practices, and solo practices.
AHRQ-funded; HS000029.
Citation: van Hasselt M, McCall N, Keyes V .
Total cost of care lower among Medicare fee-for-service beneficiaries receiving care from patient-centered medical homes.
Health Serv Res 2015 Feb;50(1):253-72. doi: 10.1111/1475-6773.12217.
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Keywords: Healthcare Costs, Medicare, Nursing Homes, Patient-Centered Healthcare
Sheppard KD, Brown CJ, Hearld KR
Symptom burden predicts nursing home admissions among older adults.
Using a sample of community-dwelling Medicare beneficiaries in Alabama who were contacted by telephone every 6 months during an eight and a half-year study, researchers found that symptom burden is an independent risk factor for NH admission. The study suggests that symptom assessment and management may reduce NH utilization.
AHRQ-funded; HS013852
Citation: Sheppard KD, Brown CJ, Hearld KR .
Symptom burden predicts nursing home admissions among older adults.
J Pain Symptom Manage. 2013 Oct;46(4):591-7. doi: 10.1016/j.jpainsymman.2012.10...
Keywords: Medicare, Long-Term Care, Elderly, Nursing Homes, Healthcare Costs