Nursing home residents with advanced dementia who were covered under a Medicare managed care plan were more likely to have a do-not-hospitalize order and less likely to be transferred to a hospital, a new study finds
Those covered under fee-for-service Medicare were more likely to end up in a hospital. The managed care residents were also more likely to have primary care visits in the nursing home and more nursing home-based nurse practitioner visits, according to researcher Keith S. Goldfeld, Dr.P.H., M.S., M.P.A., of the NYU School of Medicine. He and colleagues analyzed data from the CASCADE study, in which more than 300 nursing home residents in 22 nursing homes in the Boston area were monitored over 18 months.
“First, more onsite nurse practitioners in nursing homes resulted in better outcomes irrespective of insurance status,” wrote William J. Hall, M.D., M.A.C.P. in a commentary. “Second, present Medicaid reimbursement creates perverse incentives against the delivery of appropriate comfort and palliative care such as hospital services.”
Hall also argued that no person should be admitted to a hospital or a nursing home without physician authorization, and that physicians have a responsibility to advocate for an “appropriate level of care” for patients with advanced dementia.
Results appeared in JAMA Internal Medicine.