Longitudinal Study of the Impact of Medicaid Prospective Reimbursement on Nursing Home Care in Maine. Report 4. The Impact of Prospective Reimbursement on Nursing Home Costs, Access to Care and Quality of Care

摘要

The study examined the impact of Medicaid's nursing home prospective payment system in Maine on cost containment, access to care, and quality of care. The study design involved interrupted time-series regression models. Six years of nursing home cost report, case-mix, and quality of care data were collected from the 136 nursing homes operating in the state of Maine as of July 1982. Case-mix data were collected on 14,645 nursing home residents representing 84 nursing homes. Final analyses were performed on a sample of 446 facilities for which complete cost report, case-mix, and quality data were available. The study found that total variable costs per patient day were reduced ($3.03) by the third year of the payment system. There appeared to be no significant impact on nursing home profitability as measured by operating margin--the ratio of net operating income to total operating revenue. The study observed no significant impact on structural and outcome quality of care measures developed for the study; however, the process measure of quality of care and nursing hours per patient day, was reduced by almost 15 minutes per patient day by the third prospective year. Access to care for Medicaid recipients, as measured by the percentage of Medicaid patient days to total patient days, declined by 5.5% by the third payment year. Case-mix was not affected.