Study: Case-mix Medicaid reimbursement systems contain disincentives for nursing home quality improvement

Share this article:
Editors' Blog: Nursing homes show quality improvement
Editors' Blog: Nursing homes show quality improvement
Nursing home Medicaid reimbursement systems can work to improve quality of care—but they have to be used the right way, a new report suggests.

The Long-Term Care Community Coalition (LTCCC) conducted a one-year study of 35 states that use a case-mix Medicaid reimbursement system—a system that reimburses nursing homes based both on quality performance and facility costs. The system has a few built-in disincentives for quality improvement, the study finds. Because residents who require a high level of care bring in more Medicaid money, those who don't may be passed over for care. Also, when heavy care patients improve, they are downgraded to a lower reimbursement category.

The coalition makes a few recommendations for nursing homes and states to improve the use of Medicaid reimbursements. By encouraging spending in direct care and by shifting the focus of reimbursements away from facility costs and toward quality measures, overall quality of care could improve. Also, identifying specific patient needs, setting goals for reimbursement incentives and mandating program and outcome requirements for residents may help improve access for both heavy-care and lighter-care residents.

The report focuses specifically on New York state and its reimbursement system, but takes into account 34 other states with similar systems. The full report can be found online at www.nursinghome411.org.

Share this article:

More in News

Skilled nursing facilities with poor quality ratings do not readmit more patients to hospitals, researchers find

Skilled nursing facilities with poor quality ratings do ...

Low-quality and high-quality skilled nursing facilities readmit about the same proportion of residents to hospitals, suggest research findings recently published in the American Journal of Medical Quality.

Cipro and related antibiotics increase MRSA risk in long-term care facilities, study ...

Long-term care residents on a fluoroquinolone antibiotic such as Cipro are at an increased risk for methicillin-resistant Staphylococcus aureus, researchers in France have found.

Jonathan Blum, who oversaw long-term care reforms, resigns as head of Medicare

The nation's top Medicare official, Jonathan Blum, is leaving his post next month, news outlets reported Tuesday. Blum became a familiar figure to long-term care providers through Open Door Forum calls and other outreach efforts during his five-year tenure, as he guided implementation of Medicare ...