ArticleHealth services research2008
Has the Medicare prospective payment system led to increased nursing home efficiency?
Article in Health services research, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- A Systematic Literature Review of Efficiency Measurement in Nursing Homes.International journal of environmental research and public health · 2019Pooled it
- Evaluating the technical efficiency of care among long-term care facilities in Xiamen, China: based on data envelopment analysis and Tobit model.BMC public health · 2019Article
- Technical efficiency of nursing homes: do five-star quality ratings matter?Health care management science · 2018Article
- Using nonparametric conditional approach to integrate quality into efficiency analysis: empirical evidence from cardiology departments.Health care management science · 2017Article
- Cost efficiency of nursing homes: do five-star quality ratings matter?Health care management science · 2017Article
- Using data envelopment analysis for assessing the performance of pediatric emergency department physicians.Health care management science · 2017Article
- Decomposing Cost Efficiency in Regional Long-term Care Provision in Japan.Global journal of health science · 2015Article
- Intertemporal analysis of organizational productivity in residential aged care networks: scenario analyses for setting policy targets.Health care management science · 2014Article
- Efficiency and quality of care in nursing homes: an Italian case study.Health care management science · 2011Article
- Explaining the efficiency of local health departments in the U.S.: an exploratory analysis.Health care management science · 2010Article
- Factors associated with increasing nursing home closures.Health services research · 2009Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
RESEARCH
objectiveTo assess the impact of recent Medicare prospective payment system (PPS) changes on efficiency in skilled nursing homes. DATA SOURCE/STUDY
settingMedicare Cost Reports (MCR), On-line Survey Certification and Reporting System (OSCAR), Area Resource Files (ARF), a Centers for Medicare and Medicaid Services (CMS) hospital wage index website, a Consumer Price Index (CPI) database, and a survey of state Medicaid reimbursement rates. The sample was 8,361 nursing homes in the Medicare Cost Report databases from the years 1997 to 2003. STUDY
designData-envelopment analyses (DEA) calculated efficiency scores for three separate DEA models: unadjusted, acuity-adjusted, and acuity-and-quality-adjusted efficiency. The efficiency scores from these models were regressed on the Medicare PPS changes (the Balanced Budget Act [BBA], the Balanced Budget Refinement Act [BBRA] and the Benefits Improvement and Protection Act) and other organizational and market explanatory variables using a panel-data truncated regression. PRINCIPAL
findingsMean values for all efficiency measures decreased over time, the acuity-quality-adjusted efficiency measures decreasing the most. All policy variables were significantly negatively related to all efficiency measures. Higher nurse staffing was negatively related to efficiency in all but the acuity-quality-adjusted model. Other explanatory variables varied in their relationships to the efficiency variables.
conclusionsThe results suggest that the reimbursement policy changes had a significantly negative impact on efficiency. Higher nurse staffing contributed to lower efficiency only when efficiency was not adjusted for quality. Various organizational and market factors also played significant roles in all efficiency models.
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Registered trials
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