Paying for Nursing Home Quality: An Elusive But Important Goal

Grabowski, David C.; Chen, Amanda; Saliba, Debra

doi:10.1111/jgs.18260

Cited by 4 publications

(5 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although this study is cross‐sectional and cannot causally link any dementia‐focused care tools with benefits for short‐stay patients with dementia, our findings permit hypothesis generation to guide future research to improve SNF care delivery, which has been an elusive, but high‐priority goal 4,36,37 . Given the positive associations identified for short‐stay dementia patients receiving care from a facility using dementia care units, our findings suggest that there may be some additive benefit from offering a tailored physical environment for those with dementia.…”

Section: Discussionmentioning

confidence: 88%

Impact of dementia special care units for short‐stay nursing home patients

Chen,

Epstein,

Joynt Maddox

et al. 2023

J American Geriatrics Society

Self Cite

View full text Add to dashboard Cite

BackgroundImproving quality of care provided to short‐stay patients with dementia in nursing homes is a policy priority. However, it is unknown whether dementia‐focused care strategies are associated with improved clinical outcomes or lower utilization and costs for short‐stay dementia patients.MethodsWe performed a national survey of nursing home administrators in 2020–2021, asking about the presence of three dementia‐focused care services used for their short‐stay patients: (1) a dementia care unit, (2) cognitive deficiency training for staff, and (3) dementia‐specific occupational therapy. Using Medicare claims, we identified short‐stay episodes for beneficiaries residing in surveyed skilled nursing facilities (SNFs) with and without dementia. We compared clinical, cost, and utilization outcomes for dementia patients in SNFs, which did and did not offer dementia‐focused care services. As a counterfactual control, we compared these differences to those for non‐dementia patients in the same facilities. Our primary quantity of interest was an interaction term between a patients' dementia status and the presence of a dementia‐focused care tool.ResultsThe study population included 102,860 Medicare episodes of care from 377 SNF survey respondents in 2018–2019. In adjusted comparisons of the interaction between dementia status and the presence of each dementia‐focused care tool, dementia care units were associated with a 1.5‐day increase in healthy days at home in the 90 days following discharge (p = 0.01) and a 3.1% decrease in the likelihood of a subsequent SNF admission (p = 0.001). Cognitive deficiency training was also associated with a 2.0% increase in antipsychotics (p = 0.03), whereas dementia‐specific occupational therapy was associated with a 1.2% increase in falls (p = 0.01) per patient episode.ConclusionsSelf‐reported use of dementia care units for short‐stay patients was associated with modestly better performance in some, but not all, outcome measures. This provides hypothesis‐generating evidence that dementia care units could be a promising mechanism to improve care delivery in nursing homes.

show abstract

Section: Discussionmentioning

confidence: 88%

Impact of dementia special care units for short‐stay nursing home patients

Chen,

Epstein,

Joynt Maddox

et al. 2023

J American Geriatrics Society

Self Cite

View full text Add to dashboard Cite

show abstract

“…The April 1, 2021, Medicare Payment Advisory Council mandated congressional report noted multiple flaws in the current SNF VBP program including higher payment adjustments for providers that had lower average risk scores, overall payments lowered for the majority of SNFs, most SNFs did not earn back any portion of the 2% withheld and few SNFs received the maximum increase 29 . The 2023 article by Grabowski et al on the National Academies of Sciences, Engineering, and Medicine (NASEM) report on improving nursing home quality provides a review of the history of nursing home value‐based payment initiatives citing several studies that indicated facilities serving vulnerable groups were more likely to be penalized than receive bonuses and that the program did not improve readmission rates for the lowest performing facilities 4,30–32 . The NASEM report itself states that, to date, the SNF VBP program has not demonstrated an effect on readmission rates 33 .…”

Section: Discussionmentioning

confidence: 99%

“…29 The 2023 article by Grabowski et al on the National Academies of Sciences, Engineering, and Medicine (NASEM) report on improving nursing home quality provides a review of the history of nursing home valuebased payment initiatives citing several studies that indicated facilities serving vulnerable groups were more likely to be penalized than receive bonuses and that the program did not improve readmission rates for the lowest performing facilities. 4,[30][31][32] The NASEM report itself states that, to date, the SNF VBP program has not demonstrated an effect on readmission rates. 33 In response to the NASEM report, The Moving Forward Nursing Home Quality Coalition has been established to advance seven quality goals including the creation of a more rational and robust financing system.…”

Section: Discussionmentioning

confidence: 99%

Increasing illness severity of skilled nursing facility patients over time: Implications for readmission penalties

Siskind,

Dhansew,

Burns

et al. 2023

J American Geriatrics Society

View full text Add to dashboard Cite

BackgroundCurrent financial penalties for rehospitalization of skilled nursing facilities (SNFs) patients are based in part on the studies by Ouslander et al., 2011, and Mor et al., 2010, demonstrating that many SNF hospitalizations were avoidable. With increasing age, complex illness severity, and use of SNFs for subacute rehabilitation, readmission metrics and financial penalties based on previous data may be due for reevaluation.MethodsRetrospective electronic medical record (EMR) review of 21,591 admissions and discharges between 2010 and 2019 inclusive. Data extracted included demographics, LACE, Charlson comorbidity index (CCI), and simplified HOSPITAL score parameters. The scores were calculated for the study years from the extracted data. Patients readmitted to the hospital within 30 days were identified.ResultsMean yearly score of all three indices rose steadily: LACE score 10.76–12.04 (0.43 estimated annual increase, 95% CI [0.39, 0.46]), CCI 4.26–5.05 (0.31 estimated annual increase, 95% CI [0.27, 0.34]), and simplified HOSPITAL score 3.46–4.03 (0.21 estimated annual increase, 95% CI [0.18, 0.24]). The estimated probability of readmission across observed CCI scores ranged from 15.4% to 15.9%, 95% CI bounds (10.8%, 22.7%). The estimated probability of readmission across observed LACE scores ranged from 4.7% to 36.3%, 95% CI bounds (3.4%, 54.7%). The estimated probability of readmission across observed HOSPITAL scores ranged from 5.8% to 54.1%, 95% CI bounds (6.2%, 66.0%).Conclusions and ImplicationsThe study confirms anecdotal experience that the illness acuity of patients admitted to SNFs increased progressively over time and was associated with an increased risk of 30‐day readmissions to the hospital. Our study suggests that the use of clinically validated readmission risk assessment tools instead of the Skilled Nursing Facility Value‐Based Purchasing Program (SNF VBP) current risk adjustors may be a more accurate reflection of the current illness severity of a facility's patient population at the time of payment adjustment.

show abstract

“…Finally, prescriptive regulations must come with resources. Without resources, prescriptive value‐based payment models will exacerbate health inequities as low‐performing facilities care for the most disadvantaged patients 19 . Without resources, struggling NHs will continue to struggle or will close.…”

Section: Prescriptive Versus Dynamic Regulationsmentioning

confidence: 99%

“…The National Academies of Science, Engineering, and Medicine (NASEM) Report to Improve NH Quality summarizes these weaknesses and outlines recommendations moving forward. 21 Subsequently, members of this committee have published a series of articles which describe key aspects of the report, 19,[22][23][24][25] as well as important gaps that the report did not address, 26,27 such as whether post-acute care and longterm care services can be successfully integrated. While no single intervention will fix these problems, there is a strong consensus that we must begin with a series of financial and regulatory reforms.…”

Section: Implications For Practice and Policymentioning

confidence: 99%