60 Seconds with...R. Tamara Konetzka

Share this article:
R. Tamara Konetzka, associate professor, University of Chicago
R. Tamara Konetzka, associate professor, University of Chicago
Q: How does payment in skilled nursing facilities influence quality?

A: SNF payment rates, in the long run, affect investments in resources, such as hiring highly qualified staff, rather than at the point of clinical decisions.

Q: How did the Balanced Budget Act of 1997 and the introduction of the Prospective Payment System affect quality in SNFs?

A: We saw a simultaneous large cut in average payments, with the goal of greater efficiency while maintaining quality and access for Medicare residents. Researchers looked at post-acute quality outcomes and didn't see much. So it's good, strategically, to maintain post-acute quality.   

Q: What does this mean for long-stay SNF residents?


A: After the PPS was implemented, SNFs saw more adverse outcomes with pressure sore rates and urinary tract infections. Facilities decreased licensed staffing in proportion with the level of Medicare residents in the facility.

Q: What should policymakers consider when making rate cuts?

A:  In the long run, we need to consider why cross-subsidization is necessary for SNFs with high numbers of Medicaid patients. Multiple payment systems within a facility leads to strange results.
Share this article:

More in News

Bulk of Medicaid to be managed care in two years: Avalere

Bulk of Medicaid to be managed care in ...

More than three-quarters of Medicaid beneficiaries will be enrolled in a managed care plan as of 2016, according to an Avalere Health analysis released Thursday. The numbers reveal that managed ...

Nursing home asked for employee's personal information too often, jury rules

The human resources department of a Maine nursing home did not properly protect a former employee's personal identification information, a jury recently ruled.

Test could confirm sepsis within an hour

Nursing home residents might benefit from a new way of diagnosing and treating sepsis made possible by discoveries out of the University of British Columbia.