Nursing homes more likely to send Medicaid recipients to hospital, study says

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Nursing homes more likely to send Medicaid recipients to hospital, study says
Nursing homes more likely to send Medicaid recipients to hospital, study says

Medicaid beneficiaries in a nursing home are 27% more likely than private pay residents to be sent to a hospital rather than be treated on-site, according to a new study.

Researchers at the University of Rochester Medical Center analyzed records of 67,256 nursing home residents in 545 New York facilities. They said it was traditionally assumed that Medicaid patients were hospitalized more frequently because they were admitted to skilled nursing facilities with fewer resources.

But it's actually a question of money, the investigators found. Since Medicaid reimburses nursing homes at a rate lower than the cost needed to provide intensive care on-site, nursing homes have an incentive to send their residents to a hospital. The hospital and Medicare therefore absorb the costs of treating the sick resident, the investigators said.

“While we know that nursing homes tend to provide similar quality of care to all residents, hospitalization decisions are often different from the decisions involved in the provision of daily care and have a significant impact on the long-term health of residents,” said lead researcher, Shubing Cai, Ph.D., in a statement. The authors point to programs like a pay-for-performance project from the Centers for Medicare & Medicaid Services as a way to provide incentives for SNFs to decrease hospitalization rates.  

The study was published in the October issue of the journal Medical Care Research and Review.
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