Abstract
Objectives
Successful discharge of nursing home (NH) residents to community has been reported
in Nursing Home Compare (NHCompare) as a quality indicator, yet it is likely influenced
by the availability of home- and community-based services (HCBS). Medicaid NH reimbursement
rates and bed-hold policies have been shown to be related to quality of care, which
may also affect successful discharge. This study explores the relationship of state
Medicaid long-term care policies and successful discharge.
Design
Longitudinal study of Medicaid policies and NHCompare successful discharge rates over
3 time periods, 2014-2015, 2015-2016, and 2016-2017, using generalized estimating
equation models.
Setting and participants
11,694 unique NHs.
Measures
Risk-adjusted rates of successful discharge were downloaded from NHCompare. Truven's
“Medicaid Expenditures for Long-term Services and Supports” reports provided states'
expenditures on HCBS and NHs. Details of bed-hold policies in 2014 were obtained from
the Medicaid and CHIP Payment and Access Commission. Data on NH and market characteristics
were extracted from LTCFocUs.org and Area Health Resources File.
Results
The national average-adjusted successful discharge rates were 49.7%, 56.8%, and 56.2%
in 2014-2015, 2015-2016, and 2016-2017, respectively. In 2015, states spent between
30.6% (Mississippi) and 82.2% (Oregon) on HCBS, with an overall average of 53.1%.
States reimbursed NHs, on average, $185.7 per resident day. Five percent increase
in Medicaid spending for HCBS was statistically significantly associated with 0.47%
higher successful discharge rates. Compared to NHs in states with reimbursement rates
in the first quartile (≤$152), NHs in the second ($153-$178), third ($179-$212), and
fourth (≥$213) quartiles were associated with 2.33%, 1.86%, and 1.15% higher successful
discharge rates (all P < .01). Results were stronger in states without bed-hold policies.
Conclusions/Implications
This study provides promising evidence to state governments that shifting expenditures
from institutions to communities as well as more generous reimbursements to NHs may
improve quality of care in NHs.
Keywords
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Article info
Publication history
Published online: March 25, 2019
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
