Abstract
Objectives
Medicaid nursing home (NH) reimbursement rates and bed-hold policies have been shown
to be associated with hospitalization of urban NH residents, but their relationships
with emergency department (ED) visits, especially in rural NHs, remain unknown. This
study explores the relationships of Medicaid NH policies with three NH quarterly risk-adjusted
rates of ED use for long-stay residents and evaluates whether the associations differed
by NHs' geographical locations.
Design
Longitudinal study of Medicaid policies and NH risk-adjusted rates over 3 quarters
(2011 Q3, 2012 Q3, and 2013 Q3), using Generalized Estimating Equation (GEE) models.
Setting and Participants
14,514 unique NHs.
Measures
Quarterly risk-adjusted rates of any ED visit, ED visits without hospitalization or
observation stay (outpatient ED), and potentially avoidable ED visits (PAED) were
calculated from national Medicare claims and NH Minimum Data Set 3.0. Medicaid policies
were consolidated from several publicly available sources. NH and market characteristics
were extracted from the Certification And Survey Provider Enhanced Reporting and the
Area Health Resources File.
Results
In 2012, states reimbursed NHs, on average, $162.60 per resident-day, and 36 states
employed bed-hold policies. Although a $10 increase in reimbursement rates was associated
with statistically significantly lower rates of any ED, outpatient ED, and PAED in
both urban and micropolitan NHs (−0.79%, −1.09%, and −1.02% for urban NHs; −1.29%, −1.90%,
and −3.22% for micropolitan NHs, respectively), it was not associated with any ED
measure in rural NHs. Medicaid bed-hold polices were associated with about 9% to 12%
lower rates of all types of ED visits in urban NHs, but were not related to any of
the ED measures in micropolitan and rural NHs.
Conclusions and Implications
Associations of Medicaid NH policies with ED utilization are weaker in rural NHs than
urban NHs. Yet, the financial viability of increasing Medicaid reimbursement to reduce
the ED use may not be cost-effective.
Keywords
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Article info
Publication history
Published online: July 10, 2020
Footnotes
John Bowblis owns Bowblis Economic Consulting, which provides consulting services to long-term care providers. None of the material discussed in this paper are directly related to these services.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
