Mor V, Zinn J, Teno J, Miller S, Angelleli J, Gifford D; Academy for Health Services Research and Health Policy. Meeting.

Abstr Acad Health Serv Res Health Policy Meet. 2002; 19: 8.

Brown University Medical School, Box G-A418, Providence, RI 02912; Tel: (401) 863-2959; Fax: (401) 863-3713; E-mail: Vincent_Mor@brown.edu

RESEARCH OBJECTIVE: Accountability has been called the third revolution of medical care. The Center for Medicare & Medicaid (CMS) intends to report nursing home (NH) quality outcome indicators along with other information to the public. The implications of public reporting of quality on the NH industry is unknown. Theoretically, shifts in consumer demand will result in lower occupancy of nursing homes with poor quality, leading to closure. Some NHs may lack the human and capital resources to improve their quality of care. In order to understand the potential impact of public reporting of NH quality as proposed by CMS, we undertook a secondary analysis of national NH data bases to characterize and describe the outcomes of NHs which have limited revenue and are presumed to be "resource poor". Thus, we identified "resource poor" NHs based upon the mix of resident revenue (e.g. Medicaid, Medicare, other) and compared them to other facilities in terms of location, staffing, specialized progams, case-mix, change of ownership, loss of certification and various measures of quality care. STUDY DESIGN: Using longitudinal and cross-sectional On-line Survey and Certification Automated Record (OSCAR) data as well as resident MDS National Repository data for all US nursing homes in 1999, this study compares resource poor (with greater than 90% of residents supported by Medicaid and no more than 2% supported by Medicare) and non-poor facilities in terms of: 1) closure rates over two different 24 month periods (1993-95; 1996-98); staffing and service program features; 3) resident composition, including race; and 4) various indicators of quality adjusted for the types of residents served. POPULATION STUDIED: All non-hospital based Medicare/Medicaid nursing homes in the U.S. between 1993 and 2000 and the residents of those facilities in 1999. PRINCIPAL FINDINGS: Twelve percent of non-hospital based US certified NFs were classified as resource poor in 2000. Overall, our analyses found strong evidence that resource poor facilities are disadvantaged and that the residents they serve are disadvantaged. Resource poor facilities were more likely to located in counties, both rural and urban, in the bottom quintile of per capita income (14% vs. 19% urban & 5% vs. 27% rural), to terminate program participation (6% vs. 13% in the later period), to house patients with prior psychiatric disease and mental retardation and to have fewer nurses, physician externders or to have special care units. In virtually all states, African American nursing home residents were 3 to 6 times more likely to reside in resource poor facilities than were their white counterparts. Finally,in terms of quality outcomes, adjusting for the mix of residents entering the homes, residents of resource poor nursing facilities without specific psychiatric problems were more likely to be receiving anti-psychotics (.18 vs. .13) , residents at high risk of acquiring a pressure ulcer were more likely to have one (.18 vs. .16) and all residents were more likely to be restrained ( .11 vs. .10), Finally, controlling for state, resource poor facilities were significantly more likely to have been cited with significant health care deficiencies during inspections. CONCLUSIONS: Across all states, resource poor facilities are located in more impoverished areas and are most prevalent in the poorest states. They are predominantly isolated in racially segregated neighborhoods with lower staffing ratios and with a profile of poorer quality. Higher rates of closure and ownership change suggest that the increasingly competitive nursing home market will result in a disproportionate number of facilities going out of business resulting in less access for the poor, Medicaid long term care users in the poorest part of the country. If public reporting accelerates NH closures, our results suggest that disproportionate closing of facilities located in disadvantaged areas could diminish local access to NH for the poor and minorities. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: State policy makers should consider various ameliorative strategies to either "rescue" poor performing facilities and break the cycle and/or establish risk pool funds to facilitate transfer of residents to alternate facilities with a better quality profile. Regardless, states must be prepared to respond to the fact that federal policies may have unintended policies that will affect certain areas differentially. PRIMARY FUNDING SOURCE: The Robert Wood Johnson Foundation, NIA & The Robert Wood Johnson Foundation

Publication Types:

• Meeting Abstracts

Keywords:

• African Americans
• Cross-Sectional Studies
• Delivery of Health Care
• Diagnosis-Related Groups
• Health Resources
• Humans
• Long-Term Care
• Medicaid
• Medicare
• Nursing Homes
• Ownership
• Poverty
• Pressure Ulcer
• Quality Indicators, Health Care
• United States
• economics
• hsrmtgs

Other ID:

• GWHSR0002513

UI: 102274189

From Meeting Abstracts