Medicaid Supplemental Payments and Nursing Home Quality – a Case Study of Indiana

医疗补助补助金和疗养院质量 — 印第安纳州案例研究

• 批准号: 9976249
• 负责人: Hari Sharma
• 金额: $ 4.95万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9976249
• 关键词: Medicaid; Supplemental; Payments; Nursing; Home

Project Summary: More than a million residents live in nursing homes in the United States at a cost of about 55 billion dollars to Medicaid. Nursing home quality has been a longstanding concern among policymakers. Adequate reimbursements are essential to improve quality in nursing homes. Although state and the federal governments jointly finance Medicaid, states have created various supplemental payment programs that rely on funds from the providers and local governments to finance the non-federal share. Supplemental payment program for nursing homes owned/operated by non-state governmental organizations (NSGOs) is one such program under which NSGOs contribute the state’s share of the supplemental payment to the state government through intergovernmental transfers. The state then claims federal matching dollars for the supplemental payment and transfers the supplemental payments to the NSGO-owned nursing home. Nursing homes and NSGOs share these funds based on their contract and nursing home expenditures. This program allows states to increase Medicaid reimbursement for NSGO-owned nursing homes without substantial burden on state budgets. Indiana offers a unique opportunity to study the effectiveness of the supplemental payment program to NSGO- owned/operated nursing homes because NSGOs bought/leased about 90% of nursing homes in Indiana during the past decade. In 2017, NSGO-owned nursing homes in Indiana received about 700 million in additional federal dollars under this program. Anecdotal newspaper articles suggest that NSGOs keep a large portion of the supplemental payments and that staffing has not improved in NSGO-owned nursing homes. Policymakers are increasingly concerned that NSGOs are using the supplemental payment program to boost their own revenues instead of helping improve the quality of nursing homes. Our objective is to evaluate the effectiveness of Indiana’s supplemental payments to NSGO-owned nursing homes in increasing nursing home revenue and expenditures and improving nursing home staffing and patient safety. To achieve this goal, we propose an econometric analysis for three specific aims: 1) To estimate the effect of supplemental payments to NSGO-owned facilities on nursing home revenue/expenditures, 2) To estimate the effect of supplemental payments to NSGO-owned facilities on direct care staffing (RN, LPN, and Nurse-aide); and 3) To estimate the effect of supplemental payments to NSGO-owned facilities on patient safety outcomes (pressure ulcers, infections, falls, and medication errors). Our results have the potential to affect CMS policies on states’ use of nursing home supplemental payment program by providing rigorous estimates on whether these payments had the intended effect of improving nursing home quality. Our results will provide empirical evidence for state and national policymakers on whether these programs represent efficient allocation of resources to improve nursing home quality.

项目摘要： 超过一百万的居民居住在美国的养老院，耗资约550亿美元 医疗补助质量一直是政策制定者的长期关注 报销对于提高疗养院的质量至关重要。 共同为医疗补助提供了融资，各州从 提供者和地方政府为非联邦份额提供资金。 非州政府组织（NSGO）拥有/经营的疗养院就是这样的计划。 NSGO通过 政府间转移。 将供应付款转移给NSGO拥有的疗养院。 这些基于其合同和疗养院支出的资金允许各州增加 NSGO拥有的养老院的医疗补助报销没有大量预算。 印第安纳州提供了Aunique的机会，可以研究对NSGO-的补充支付计划的有效性 - 所有人/经营的疗养院是因为NSGO在印第安纳州购买/租赁了约90％的疗养院 过去十年。 该计划下的联邦政府。 NSGO拥有的疗养院尚未改善补充付款和人员。 越来越担心NSGO正在使用Suppplemental付款支付计划来提高自己的 收入而不是帮助养老金的质量。 印第安纳州向NSGO拥有的Nsursing Homes支付的供应支付的有效性，以增加护理养老院 收入和支出以及改善疗养院的人员和天堂安全。 提出针对三个具体目的的计量经济学分析：1）估算促销支付的影响 NSGO拥有的疗养院收入/支出的设施 支付直接护理人员的NSGO拥有的设施（RN，LPN和护士Aide）； 向NSGO拥有的设施补充支付对患者安全安全结果的影响（压溃疡， 感染，跌倒和药物错误）我们的结果有可能影响CMS政策 疗养院供应付款计划通过对这些付款是否有的估算 提高疗养院质量的预期影响。 该计划中的国家决策者代表资源分配效率以改善护理 家庭质量。