Medicare prospective payment and quality of care for long-stay nursing facility residents
Medicare prospective payment and quality of care for long-stay nursing facility residents
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DOI：
10.1097/01.mlr.0000199693.82572.19
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发表时间：
2006-03-01
期刊：
影响因子：
3
通讯作者：
Stearns, SC
中科院分区：
文献类型：
--
作者：
Konetzka, RT;Norton, EC;Stearns, SC
背景：1997年的平衡预算法案极大地改变了医疗保险支付熟练护理设施的方式，并降低了每日费率。以前的研究发现，对设施范围内的人员配置的影响，但对短期停留居民的质量没有影响。由于设施可以结合联合收割机的收入流，用于需要的地方，溢出效应的护理质量为长期stayingresidents.Objective：我们试图调查的影响，财政压力的医疗保险支付的变化对护理质量为长期stayingresident。我们调查了医疗保险对熟练护理设施的预期支付系统对尿路感染和压疮发生率的影响，长期居住的居民，同时控制居民的严重程度。我们使用1995年至2000年的最小数据集数据，对俄亥俄州、堪萨斯、缅因州、密西西比和南达科他州的养老院居民进行了面板数据分析。每个设施的医疗保险的依赖性被用来分离的政策的影响，从根本上的行业trends.Results：发展尿路感染或压疮的概率显着增加后，医疗保险的预期支付系统实施的长期居住的居民。影响大致成比例的居民在一个设施所覆盖的Medicare.Conclusions：虽然医疗保险的预期付款和利率下调直接适用于医疗保险（主要是短期停留）居民在熟练的护理设施，由此产生的财务压力降低了长期居住的居民所经历的护理质量，如测量的可能性的不良后果。观察到的质量下降可能是由于减少支付促使护士人员减少。
Background: The Balanced Budget Act of 1997 dramatically changed the way that Medicare pays skilled nursing facilities and also cut per-diem rates. Previous studies have found effects on facility-wide staffing but not on quality for short-stay residents. Because facilities may combine revenue streams to be used where needed, spillover effects on quality of care for long-stay residents are possible.Objective: We sought to investigate effects of financial pressures from Medicare payment changes on quality of care for long-stay residents.Methods: We investigated the effect of Medicare's Prospective Payment System for skilled nursing facilities on incidence of urinary tract infections and pressure sores among long-stay residents while controlling for resident severity. We conducted panel data analysis of nursing home residents in Ohio, Kansas, Maine, Mississippi, and South Dakota using Minimum Data Set data from 1995 to 2000. Each facility's Medicare dependence was used to separate effects of the policy from underlying industry trends.Results: The probability of developing a urinary tract infection or pressure sore increased significantly among long-stay residents after Medicare's prospective payment system was implemented. Effects were roughly proportional to the percent of residents in a facility covered by Medicare.Conclusions: Although Medicare prospective payment and rate cuts were directly applicable only to Medicare (largely short-stay) residents in skilled nursing facilities, the resulting financial pressures lowered the quality of care experienced by long-stay residents, as measured by the likelihood of adverse outcomes. The observed quality decreases were likely due to decreases in nurse staffing prompted by the payment reductions.