Government health programs could save money and health outcomes could improve if more dual-eligible beneficiaries were to go from hospitals to well-staffed long-term and post-acute facilities, according to research from Brown and Harvard universities.

Hospital patients eligible both for Medicare and Medicaid are discharged to nursing homes with low nurse-to-patient ratios more commonly than Medicare-only patients, according to a May study in Medical Care Research and Review. The report also suggests that dual eligibles are twice as likely to become long-stay residents.

Often, duals have more complex health conditions and are more likely to lack resources — such as home equity — to enable non-institutional care. Being in a skilled nursing facility in the top 20% in terms of staffing, however, significantly narrows the gap between duals and Medicare-only patients when it comes to the likelihood of becoming a long-stay resident, according to the analysis. SNFs with high nurse staffing often specialize in the treatment of post-acute patients and may not be willing to treat dual-eligible patients for longer periods.

The analysis also showed that across all SNFs, duals’ adjusted hospitalization rates were equal to or lower than Medicare-only rates. 

“Changes in the current SNF care referral process have the potential to reduce excess SNF utilization by dual-eligible beneficiaries and could help reduce spending by both Medicare and Medicaid,” the authors wrote.

Investigators analyzed about 907,000 hospital patients discharged to a SNF between 2008 and 2009, of whom 19% were dual eligible. Data came from sources such as the Minimum Data Set, Medicare enrollment and claims files.