Nursing Home Hospitalization Influenced by Payer Status -from

  • Date 10.19.2011
  • Categories News

Nursing Home Hospitalization Influenced by Payer Status -from

Article from by Caitlin Bronson

A nursing home often decides whether or not to send an ill resident to the hospital or treat them on-site depending on their insurance status, a new study from the University of Rochester Medical Center found. As reported by ScienceDaily, residents enrolled in Medicaid are 27 percent more likely to be taken to the hospital than residents with private insurance.

And that often mean higher health care costs and poorer outcomes, said lead author Shubing Cai of Brown University.

"Nursing homes, in many instances, have discretion in whether to keep a patient in the facility and expend additional resources, or transfer the resident to the hospital," Cai said. "While we know that nursing homes tend to provide similar quality of care to all residents, hospitalization decisions are often different from the decisions involved in the provision of daily care and have a significant impact on the long-term health of residents."

According to the same publication, hospitalization of elderly patients is often linked with poor outcomes leading to further physical and psychological decline. Patients are more vulnerable to infections while in the hospital, experience a disruption in care and have been show to decline more quickly in functional status and become more confused.

The study authors recommend aligning incentives with Medicare and Medicaid, so that nursing homes are paid based on quality measures, including hospitalization rates.

ScienceDaily noted that Medicaid often reimburses nursing homes at a lower rate for treatment than does private pay insurance, and often below the necessary cost to provide onsite intensive care. That means nursing homes have a strong financial incentive to send ill residents on Medicaid to the hospital, where they know the cost will be taken care of by Medicare.


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