Wednesday October 19, 2011
Article from Thirdage.com- by Caitlin
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.