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Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi‐Cal Long‐Term Care Reimbursement Act of 2004 in California
Author(s) -
Xing Jingping,
Mukamel Dana B.,
Glance Laurent G.,
Zhang Ning,
TemkinGreener Helena
Publication year - 2016
Publication title -
world medical and health policy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.326
H-Index - 11
ISSN - 1948-4682
DOI - 10.1002/wmh3.194
Subject(s) - reimbursement , medicaid , payment , incentive , revenue , medicine , long term care , family medicine , pay for performance , nursing , business , health care , finance , economics , economic growth , microeconomics
Poor nursing home (NH) quality of care has been a matter of great concern. In 2005, the Medi‐Cal Long‐Term Care Reimbursement Act (AB1629) was enacted in California, changing NH reimbursement methodology from flat rate to cost‐based, facility‐specific rate. We examined changes in time trends for risk‐adjusted quality measures before and after AB1629 implementation (2002–08). Stratified analyses were performed by the proportion of Medi‐Cal revenues, which were related to the payment incentives. Three of the five quality measures—pressure ulcers, physical restraints, and incontinence—exhibited improvement while two (functional decline and potentially avoidable hospitalization) did not change. The decline in physical restraints was larger among NHs with high Medi‐Cal revenues than NHs with low Medi‐Cal revenues. This study provides evidence that linking Medicaid reimbursement rate to each NH's own expenditures and incentivizing NHs to invest in direct care may be effective in achieving quality improvement in some but not all areas.