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

项目总结： 美国有100多万居民住在养老院，耗资约550亿美元 医疗补助。养老院的质量一直是政策制定者关注的问题。足够 报销是提高养老院质量的关键。尽管州政府和联邦政府 联合资助医疗补助，各州创建了各种补充付款计划，这些计划依赖于 供应商和地方政府为非联邦份额提供资金。补充性付款计划 由非国家政府组织(NSGO)拥有/经营的养老院就是这样一项计划 哪些NSGO通过以下方式向州政府缴纳州政府补充付款的州份额 政府间转移支付。然后，州政府要求联邦政府为补充付款支付等额美元， 将补充款项转移到NSGO拥有的疗养院。养老院和非政府组织共享 这些资金是基于他们的合同和养老院支出。该计划允许各州增加 为NSGO拥有的疗养院提供医疗补助报销，而不会对州预算造成实质性负担。 印第安纳州提供了一个独特的机会来研究NSGO补充付款计划的有效性- 拥有/经营养老院，因为NSGO在年内购买/租赁了印第安纳州约90%的养老院 过去十年。2017年，NSGO在印第安纳州拥有的疗养院获得了约7亿美元的额外收入 在这项计划下的联邦资金。报纸上的轶事文章表明，NSGO保留了很大一部分 补充付款，NSGO拥有的疗养院的工作人员配备情况并没有改善。政策制定者 越来越担心NSGO正在利用补充支付计划来提升他们自己的 收入，而不是帮助提高养老院的质量。我们的目标是评估 印第安纳州对NSGO拥有的养老院的补充付款在增加养老院方面的效果 收入和支出，改善疗养院人员配置和病人安全。为了实现这一目标，我们 建议对三个具体目标进行计量分析：1)估计补充付款对 NSGO拥有的设施对养老院收入/支出的影响，2)评估补充方案的效果 支付给NSGO拥有的设施的直接护理人员(RN、LPN和护士助手)；以及3)估计 对NSGO拥有的设施的补充付款对患者安全结局的影响(压疮， 感染、跌倒和用药错误)。我们的结果有可能影响CMS关于各州使用 养老院补充付款计划，通过提供对这些付款是否有 提高养老院质量的预期效果。我们的结果将为国家和地区提供经验证据 国家政策制定者关于这些计划是否代表着有效地分配资源来改善护理 家居品质。

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.