Cost efficiency of nursing homes: do five-star quality ratings matter?

Dulal, Rajendra

doi:10.1007/s10729-016-9355-5

Cited by 13 publications

(9 citation statements)

References 29 publications

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“…24–25 While the measures used in the SNF star ratings have come under scrutiny in recent years, 26–30 they still provide a useful summary of SNF quality, and are also correlated with SNF costs. 31 We chose to use publicly available star ratings from Nursing Home Compare because these are the scores that Medicare enrollees would have access to when making their SNF selection.…”

Section: Study Data and Methodsmentioning

confidence: 99%

Medicare Advantage Enrollees More Likely To Enter Lower-Quality Nursing Homes Compared To Fee-For-Service Enrollees

Meyers

Mor²,

Rahman³

2018

Health Affairs

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Unlike fee-for-service (FFS) Medicare, most Medicare Advantage (MA) plans have a preferred network of care providers that serve most of a plan’s enrollees. Little is known about how the quality of care MA enrollees receive differs from that of FFS Medicare enrollees. This article evaluates the differences in the quality of skilled nursing facilities (SNFs) that Medicare Advantage and FFS beneficiaries entered in the period 2012–14. After we controlled for patients’ clinical, demographic, and residential neighborhood effects, we found that FFS Medicare patients have substantially higher probabilities of entering higher-quality SNFs (those rated four or five stars by Nursing Home Compare) and those with lower readmission rates, compared to MA enrollees. The difference between MA and FFS Medicare SNF selections was less for enrollees in higher-quality MA plans than those in lower-quality plans, but Medicare Advantage still guided patients to lower-quality facilities.

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Section: Study Data and Methodsmentioning

confidence: 99%

Medicare Advantage Enrollees More Likely To Enter Lower-Quality Nursing Homes Compared To Fee-For-Service Enrollees

Meyers

Mor²,

Rahman³

2018

Health Affairs

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“…The prominent characteristics of the nursing homes with higher efficiency scores were: for-profit (operational incentive), high occupancy rate (operational factor), and competitive market (environmental factor). Of all the studies, 18 included at least one of these characteristics, and 14 adjusted for quality [2,24,25,26,27,28,29,30,31,32,33,34,35,36]. These 14 studies each included a relatively large number of variables, ranging from 7 to 25 (mean = 15, SD = 5), and the majority of them used data envelopment analysis.…”

Section: Resultsmentioning

confidence: 99%

“…The majority of studies incorporated quality measures as control variables (19/29) or as a measure of output (13/29). Similar quality measures were used as outputs in some studies—e.g., “prevalence of falls” [2,25,28,34]—but as control variables as in others [42]. One study used quality measures (% non-ambulatory, % not self-feeding) as inputs [54].…”

Section: Resultsmentioning

confidence: 99%

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A Systematic Literature Review of Efficiency Measurement in Nursing Homes

Tran

Nguyen

Gray

et al. 2019

IJERPH

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Background: As our population ages at an increasing rate, the demand for nursing homes is rising. The challenge will be for nursing homes to maintain efficiency with limited resources while not compromising quality. This study aimed to review the nursing home efficiency literature to survey the application of efficiency methods and the measurements of inputs, outputs, facility characteristics and operational environment, with a special focus on quality measurement. Methods: We systematically searched three databases for eligible studies published in English between January 1995 and December 2018, supplemented by an exhaustive search of reference lists of included studies. The studies included were available in full text, their units of analysis were nursing homes, and the analytical methods and efficiency scores were clearly reported. Results: We identified 39 studies meeting the inclusion criteria, of which 31 accounted for quality measures. Standard efficiency measurement techniques, data envelopment analysis and stochastic frontier method, and their specifications (orientation, returns to scale, functional forms and error term assumptions) were adequately applied. Measurements of inputs, outputs and control variables were relatively homogenous while quality measures varied. Notably, most studies did not include all three quality dimensions (structure, process and outcome). One study claimed to include quality of life; however, it was not a well-validated and widely used measure. The impacts of quality on efficiency estimates were mixed. The effect of quality on the ranking of nursing home efficiency was rarely reported. Conclusions: When measuring nursing home efficiency, it is crucial to adjust for quality of care and resident’s quality of life because the ultimate output of nursing homes is quality-adjusted days living in the facility. Quality measures should reflect their multidimensionality and not be limited to quality of throughput (health-related events). More reliable estimation of nursing home efficiencies will require better routine data collection within the facility, where well-validated quality measures become an essential part of the minimum data requirement. It is also recommended that different efficiency methods and assumptions, and alternative measures of inputs, outputs and quality, are used for sensitivity analyses to ensure the robustness and validity of findings.

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“…While the measures used in the skilled nursing facility (SNF) star ratings have come under scrutiny in recent years, 10,37-39 they still provide a useful summary of SNF quality and are also correlated with SNF costs. 40 Market factors refer to county-level variables where the nursing home is located: Medicare Advantage (MA) penetration rate and urban area (1 = yes, 0 = no). MA penetration rate consists of the percent of Medicare beneficiaries enrolled in an MA plan.…”

Section: Methodsmentioning

confidence: 99%

High Medicaid Nursing Homes: Organizational and Market Factors Associated With Financial Performance

Weech‐Maldonado

Lord

Pradhan

et al. 2019

INQUIRY

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High Medicaid nursing homes (85% and higher of Medicaid residents) operate in resource-constrained environments. High Medicaid nursing homes (on average) have lower quality and poorer financial performance. However, there is significant variation in performance among high Medicaid nursing homes. The purpose of this study is to examine the organizational and market factors that may be associated with better financial performance among high Medicaid nursing homes. Data sources included Long-Term Care Focus (LTCFocus), Centers for Medicare and Medicaid Services’ (CMS) Medicare Cost Reports, CMS Nursing Home Compare, and the Area Health Resource File (AHRF) for 2009-2015. There were approximately 1108 facilities with high Medicaid per year. The dependent variables are nursing homes operating and total margin. The independent variables included size, chain affiliation, occupancy rate, percent Medicare, market competition, and county socioeconomic status. Control variables included staffing variables, resident quality, for-profit status, acuity index, percent minorities in the facility, percent Medicaid residents, metropolitan area, and Medicare Advantage penetration. Data were analyzed using generalized estimating equations with state and year fixed effects. Results suggest that organizational and market slack resources are associated with performance differentials among high Medicaid nursing homes. Higher financial performing facilities are characterized as having nurse practitioners/physician assistants, more beds, higher occupancy rate, higher Medicare and Medicaid census, and being for-profit and located in less competitive markets. Higher levels of Registered Nurse (RN) skill mix result in lower financial performance in high Medicaid nursing homes. Policy and managerial implications of the study are discussed.

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Cost efficiency of nursing homes: do five-star quality ratings matter?

Cited by 13 publications

References 29 publications

Medicare Advantage Enrollees More Likely To Enter Lower-Quality Nursing Homes Compared To Fee-For-Service Enrollees

Medicare Advantage Enrollees More Likely To Enter Lower-Quality Nursing Homes Compared To Fee-For-Service Enrollees

A Systematic Literature Review of Efficiency Measurement in Nursing Homes

High Medicaid Nursing Homes: Organizational and Market Factors Associated With Financial Performance

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