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Nursing home hospitalizations often driven by payer status
Date:10/3/2011

he nursing home in the first place. It has been estimated that approximately half of all hospitalizations of nursing home residents are unnecessary or avoidable. In 2004, Medicare paid $188 million for potentially avoidable hospitalizations among long-stay nursing home residents in New York State alone.

Hospitalization of elderly patients is also associated with poor outcomes leading to further physical and psychological decline. Patients are exposed and more vulnerable to infections in a hospital setting, experience a disruption in care, and have been shown to decline in functional status and become confused.

The study followed 67,256 nursing home residents in 545 for-profit and not-for-profit facilities in New York State representing 83 percent of the state's entire nursing home population. Hospitalization rates were highest in for-profit nursing home where Medicaid residents where 34 percent more likely to be hospitalized than private-pay residents within the same home if it qualified for bed-hold payment. Medicaid residents were 17 percent more likely to be hospitalized than private-pay residents in a not-for-profit home if the home qualified for bed-hold payment and 25 percent more likely to be hospitalized if the home did not qualify.

The authors point to efforts to provide nursing home residents more access to the care they need while staying in their residence. Private companies, such as Evercare, that provide outside, on-demand care directly to nursing homes have been associated with fewer hospitalizations. Additionally, a pay-for-performance project has been launched by the Centers for Medicare and Medicaid Services which provides payments to nursing homes based on quality measures, including hospitalization rates. Ultimately, the authors contend that the two federal programs need to devise a coordinated response.

"To reduce hospitalizations of Medicaid residents and improve both quality of care and costs, p
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Contact: Mark Michaud
mark_michaud@urmc.rochester.edu
585-273-4790
University of Rochester Medical Center
Source:Eurekalert

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