PMID: 2507623Jan 1, 1989Paper

Case-mix payment for nursing home care: lessons from Maryland

Journal of Health Politics, Policy and Law
J Feder, W J Scanlon

Abstract

Even before Medicare adopted case-based payments for hospitals, some state Medicaid programs employed case-mix payment systems for nursing home care. Their purpose was less to promote cost containment than to improve access to nursing homes for the most costly patients. This paper evaluates one such system, adopted by the state of Maryland in 1983 as part of an overall reimbursement reform. Using data on nursing home patient characteristics, costs, and staffing, as well as interviews with officials and various providers of care, the article shows that Maryland's system was successful in shifting nursing home service away from light-care and toward heavy-care patients. Furthermore, the shift occurred without inducing readily measurable declines in quality of care and with little additional administrative cost (partly because the state built its case-mix system on preexisting patient review activities). Although states could learn from and improve upon Maryland's experience--most notably in offering incentives to improve quality of care and in targeting community care on the light-care patients that nursing homes become less willing to serve--Maryland demonstrates that case-mix payment can change nursing home behavior in desired ...Continue Reading

Citations

Jun 2, 2001·The New England Journal of Medicine·G J Annas
Jan 1, 1992·Educational Gerontology·T W Samuel, J E Beaulieu
May 31, 2002·Health Services Research·Greg Arling, Barry Daneman
Aug 29, 2003·Journal of Health & Social Policy·James H Swan, Ruth B Pickard
Dec 14, 2002·Inquiry : a Journal of Medical Care Organization, Provision and Financing·David C Grabowski
May 20, 2004·Health Services Research·R Tamara KonetzkaKerry E Kilpatrick
Aug 11, 2006·Health Services Research·Zhanlian FengVincent Mor
Sep 4, 1998·Medical Care Research and Review : MCRR·C HarringtonJ H Swan
Jan 8, 1995·Journal of Aging and Health·R M Uili

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