The Effect of Payer Status on Nursing Home Residents' Hospitalizations

描述（由申请人提供）：来自养老院（NH）的住院治疗是非常值得关注的，因为它们相关的高成本，以及对虚弱的NH居民潜在的不良健康结果。研究表明，并非所有这些住院治疗都是由临床需求驱动的。特别是，研究表明，即使在考虑了他们的健康状况后，医疗补助居民的住院率也比私人支付的居民高。尽管一些研究表明，医疗补助居民比例较高的NHs更有可能使其居民住院，但尚不清楚NHs是否会对同一机构内类似医疗补助和私人支付的居民做出不同的住院决定（在本研究中称为设施内差异）。检查这些设施内的差异是很重要的，因为它们具有具体和重要的政策影响。本研究的长期目标是减少NH居民不必要的住院治疗。本提案的目的是了解非临床因素-特别是支付来源-如何影响NH居民住院的风险。具体来说，它将检查在医疗补助和类似的私人支付居民之间是否存在设施内住院差异。这项研究的基本原理是，医疗补助和私人支付之间的住院治疗在设施内的差异可能与医疗补助政策（例如医疗补助支付率和床位政策）衍生的NHs财政激励有关，而由财政激励驱动的住院治疗在临床上可能是不必要的。通过使用2009年的国家数据，这项研究有两个目的。目的-1是通过检验以下假设来检验医疗补助居民和私人支付居民在医院内住院的差异：(1)假设1：医疗补助居民比类似的私人支付居民更容易住院；(2)假设1.1：非自由裁量条件下，医疗补助与自费居民在医院内住院的差异小于自由裁量条件。目的-2是探讨设施内住院之间是否存在差异

DESCRIPTION (provided by applicant): Hospitalizations originating from nursing home (NH) are of great concern because of their related high costs, as well as the potential adverse health outcomes for frail NH residents. Studies have shown that not all of these hospitalizations are driven by clinical needs. In particular, research suggests that Medicaid residents experience a higher hospitalization rate than private-pay residents even after accounting for their health conditions. Although some studies have suggested that NHs with a higher proportion of Medicaid residents are more likely to hospitalize their residents, it is unclear whether NHs make different hospitalization decisions for similar Medicaid and private-pay residents within the same facility (referred to within-facility differences in this proposed study). It is important to examie these within-facility differences because they have specific and important policy implications. The long-term goal of this study is to reduce unnecessary hospitalizations among NH residents. The objective of this proposal is to understand how non-clinical factors - specifically payment source - affect NH residents' risk of being hospitalized. Specifically, it will examine whether thee are within-facility differences in hospitalizations between Medicaid and similar private-pay residents. The rationale for this study is that within-facility differences in hospitalizations between Medicaid and their private-pay counterparts is likely to be associated with NHs' financial incentives derived from Medicaid policies (e.g. Medicaid payment rate and bed-hold policies), and hospitalizations that are driven at the margin by financial incentives are likely tobe clinically unnecessary. By using national 2009 data, this proposed study has two aims. Aim-1 is to examine within-facility differences in hospitalizations between Medicaid and private-pay residents by testing the following hypotheses: (1) Hypothesis 1: Medicaid residents are more likely to be hospitalized than similar private-pay residents within the same NH; and (2) Hypothesis 1.1: The within-facility differences in hospitalizations between Medicaid and private-pay residents are smaller for non-discretionary conditions compared with discretionary conditions. Aim-2 is to explore whether the within-facility differences in hospitalizations between Medicaid and private-pay residents vary across states with different Medicaid policies. Although this aim is exploratory, it will pave the way to further in-depth studies of the relationship betwen Medicaid policies and potentially unnecessary hospitalizations among Medicaid residents, and ultimately provide guidance for better designed Medicaid policies. Reducing hospitalizations is an important and timely issue which is one of the current foci of the Center of Medicare and Medicaid Services (CMS) policies. Results from this study will improve our understanding of the non-clinical forces that drive differences in NH hospitalization rates between Medicaid and private-pay residents, which contribute to overall unnecessary hospitalizations. Design of effective policies to ameliorate these differences will improve NH residents' quality of care and cut Medicare costs.