Medicaid payment rates, case-mix reimbursement, and nursing home staffing - 1996-2004
Medicaid payment rates, case-mix reimbursement, and nursing home staffing - 1996-2004
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DOI：
10.1097/mlr.0b013e3181484197
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发表时间：
2008-01-01
期刊：
影响因子：
3
通讯作者：
Mor, Vincent
中科院分区：
文献类型：
--
作者：
Feng, Zhanlian;Grabowski, David C.;Mor, Vincent
目的：我们研究的影响，国家医疗补助支付率和情况组合报销直接护理人员的水平，在US nursing homes.Methods：我们使用了最近的时间序列的国家疗养院的数据从网上调查认证和报告系统为1996-2004年，合并年度国家医疗补助支付率和情况组合报销信息。根据专家建议的阈值定义了人员配置总数的5类反应措施，并在多项逻辑回归模型中进行了检查。设施固定效应模型估计分别为注册护士（RN），执业护士（LPN），和认证护士助理（CNA）的人员配置水平测量平均小时每居民day.Results：较高的医疗补助支付率与增加总的人员配置水平，以满足更高的建议阈值。然而，在总体人员配置方面的这些增长伴随着RN人员配置的减少以及LPN和CNA人员配置水平的增加。根据病例组合报销，养老院达到更高的建议人员配置阈值的可能性下降，专业人员配置水平也下降。独立的国家，市场和设施的特点的影响，有一个显着的下降趋势，在RN的人员配置和上升趋势在两个LPN和CNA的personnel.Conclusions：虽然整体人员配置可能会增加响应更慷慨的医疗补助报销，它可能不会转化为改善工作人员的技能组合。根据报销水平和住院医师的敏锐度进行调整后，在实施病例组合报销后，工作人员总数没有增加。
Objective: We examined the impact of state Medicaid payment rates and case-mix reimbursement on direct care staffing levels in US nursing homes.Methods: We used a recent time series of national nursing home data from the Online Survey Certification and Reporting system for 1996-2004, merged with annual state Medicaid payment rates and case-mix reimbursement information. A 5-category response measure of total staffing levels was defined according to expert recommended thresholds, and examined in a multinomial logistic regression model. Facility fixed-effects models were estimated separately for Registered Nurse (RN), Licensed Practical Nurse (LPN), and Certified Nurse Aide (CNA) staffing levels measured as average hours per resident day.Results: Higher Medicaid payment rates were associated with increases in total staffing levels to meet a higher recommended threshold. However, these gains in overall staffing were accompanied by a reduction of RN staffing and an increase in both LPN and CNA staffing levels. Under case-mix reimbursement, the likelihood of nursing homes achieving higher recommended staffing thresholds decreased, as did levels of professional staffing. Independent of the effects of state, market, and facility characteristics, there was a significant downward trend in RN staffing and an upward trend in both LPN and CNA staffing.Conclusions: Although overall staffing may increase in response to more generous Medicaid reimbursement, it may not translate into improvements in the skill mix of staff. Adjusting for reimbursement levels and resident acuity, total staffing has not increased after the implementation of case-mix reimbursement.