Analysis of Long-Term Care Payment Systems: A Multi-State Analysis of Medicaid Nursing Home Payment Systems, Volume 1 of 3. Final Report

摘要

The report analyzed three major payment systems for Medicaid nursing home care in 7 states: case mix (Maryland, Ohio, and West Virginia), facility specific (Colorado and Florida) and class rate (Texas and Utah) systems. Analyses of differences among the 3 payment system types in terms of case mix, quality, cost per day, Medicaid payment rate per day, and profitability were conducted. The study found that case mix was more intense in case mix as compared to class rate states, with facility specific states in between. Although facility-level analyses did not find major quality differences among payment systems, the patient-level analyses implied for most variables either the same or higher quality in case mix states compared to the other states. Also, the case studies found indications of improved quality in several states after the implementation of case mix systems. Both cost and Medicaid rate per day were found to be more directly associated with patient case mix in the case mix states than in the other states, particularly the class rate states. Average profit rates were lower in the class rate states than in the case mix or facility specific states. The association between case mix and profits was negative in class rate states, while no association was found for the case mix or facility specific states.