Omnibus Reconciliation Act Revisited

摘要

The following sections of this paper are to serve as the beginnings of an analysis of the Omnibus Budget Reconciliation Act of 1987 (OBRA). Chapter 1 lays the groundwork for determining the influence the Act has on the quality of care in nursing homes, the nursing home market, and the consumer’s perspective. In addition, information is provided on the factors that led to the creation of OBRA and the changes in government oversight. Last contained in chapter 1 is the identification of the research problem, purpose, and the research questions for a purposed study. Chapter 2 contains a discussion of the literature on factors influencing nursing homes. Discussion will include the impact of payment systems, patient perception, and quality indicators have on care and competitiveness in the nursing home industry. Chapter 3 contains a discussion on the appropriateness method and design for this study. In addition, a brief discussion of the tool used and how data will be collected and analyzed. Finally, is the reporting of results in chapter 4 and concluding with recommendations and a summation of the study in chapter 5. Chapter 1: Introduction The focus on nursing home quality by the government and consumers prompted the passage of the Omnibus Budget Reconciliation Act (OBRA) in 1987. Since the implementation of the provisions of the OBRA, nursing homes have been faced with meeting criteria for minimal quality standards. In addition, nursing homes must ensure adherence to patients’ rights for equal, safe, and quality-of-life improvement initiatives. Due to these demands, nursing homes are experiencing economic hardship related to the increase in administrative cost and changes in the nursing-home market. The growing changes in the market have created a competitive environment. Reporting databases such as the Nursing Home Quality Initiative (NHQI), Centers for Medicare and Medicaid, National Nursing Home database, and Arkansas Foundation of Medical report nursing home performance to consumers. From these databases, consumers can make health care decisions based on easily accessible comparative information. Chapter 1 serves as the beginning of an analysis of OBRA. Discussion in this chapter will lay the groundwork for exploring the influence the Act has on the quality of care in nursing homes, the nursing home market, and the consumer perspective. In addition, historical information will be provided on the factors that led to the creation of OBRA and the changes in government oversight. Last contained in this chapter is the identification of the research problem, the purpose, the significance, and the research questions for a purposed study. Background The United States has been charged with possessing a costly and ineffective health care system, and the most regulated industry (Wall, Novak & Wilkerson, 2005). The health care industry’s rapidly changing regulatory initiatives are greatly influenced by consumers, health care providers, and federal and state governments (Morris, Devlin, & Parkin, 2007). With the rapid proliferation of technology and accessibility to information, consumer demands for quality care penetrated throughout the health care system (Longest & Darr, 2008). One concern of the government and consumers is the low quality of care in nursing homes (NH) or long-term care facilities (LTC) (Kumar, Norton, & Encinosa, 2006). Statement of the Problem In 1986, the Institute of Medicine (IoM) published a manuscript detailing the poor quality of care in NH settings (Kumar, Norton, & Encinosa, 2006). The IoM report prompted concern of and action from the Federal government, influencing Congress to pass the Omnibus Budget Reconciliation Act of 1987 (Institute of Medicine, 1996). The passage of legislation essentially altered the regulation of NH operations and care of residents (Kumar, et al., 2006). The United States is a major purchaser of health care services (Folland, Allen, & Stano, 2010). According to O’Brien and Elias, 2004 (as cited by Kumar, et al, 2006) the United States government spent $103.2 billion on NH care. However, excluded from the cost fees associated with monitoring compliance, the United States paid $382 million in regulatory agency costs (Kumar, et al.). Researchers identify that the IoM report and consumer’s and government’s concern were factors that led to the passage of OBRA; however, insufficient studies have been conducted on how the passage of OBRA influenced the NH markets, quality, and consumer’s perspective after reform initiatives (Kumar, et al., 2006). Therefore, to evaluate the OBRA influence on the NH industry, a quantitative analysis of the literature was conducted. Purpose of the Study The purpose of this study is two-fold: to review the literature and to evaluate NH performance ratings of 2010. A quantitative analysis approach was used (a) to discover if passage of the OBRA 1987 has improved quality of care in the NH setting, (b) to determine if OBRA caused a shift in th