Individuals who are enrolled in Medicaid and live in nursing homes are 27 percent more likely to be sent to the hospital for treatment of an illness than individuals with private insurance, according to a new study published in the journal Medical Care Research and Review.
“Nursing homes have an incentive to hospitalize some residents more often than others,” said Helena Temkin-Greener, PhD, MPH, senior author of the study and associate professor of Community and Preventive Medicine at the University of Rochester Medical Center. “This study provides strong evidence that these financial incentives may motivate consideration of payer source in the decision whether or not to hospitalize an individual.”
When Medicaid reimburses nursing homes at a rate lower than private pay insurance, providers have “a strong financial incentive” to send sick Medicaid patients to the hospital where the cost will be absorbed by Medicare and the hospital, researchers said. States with “bed-hold” policies, which continue to pay the nursing home for Medicaid residents while they are hospitalized, also complicate the issue, according to the study.
Researchers said that while nursing homes provide the same quality of care to all residents regardless of payer source, “hospitalization decisions are often different from the decisions involved in the provision of daily care and have a significant impact on the long-term health of residents.”
Providers also drive up the cost of federal healthcare spending when hospitalizing residents for illnesses that could have been cared for in the nursing home, researchers argued.
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.