Weech-Maldonado Robert, Lord Justin, Pradhan Rohit, Davlyatov Ganisher, Dayama Neeraj, Gupta Shivani, Hearld Larry
1 The University of Alabama at Birmingham, USA.
2 Louisiana State University Shreveport, USA.
Inquiry. 2019 Jan-Dec;56:46958018825061. doi: 10.1177/0046958018825061.
High Medicaid nursing homes (85% and higher of Medicaid residents) operate in resource-constrained environments. High Medicaid nursing homes (on average) have lower quality and poorer financial performance. However, there is significant variation in performance among high Medicaid nursing homes. The purpose of this study is to examine the organizational and market factors that may be associated with better financial performance among high Medicaid nursing homes. Data sources included Long-Term Care Focus (LTCFocus), Centers for Medicare and Medicaid Services' (CMS) Medicare Cost Reports, CMS Nursing Home Compare, and the Area Health Resource File (AHRF) for 2009-2015. There were approximately 1108 facilities with high Medicaid per year. The dependent variables are nursing homes operating and total margin. The independent variables included size, chain affiliation, occupancy rate, percent Medicare, market competition, and county socioeconomic status. Control variables included staffing variables, resident quality, for-profit status, acuity index, percent minorities in the facility, percent Medicaid residents, metropolitan area, and Medicare Advantage penetration. Data were analyzed using generalized estimating equations with state and year fixed effects. Results suggest that organizational and market slack resources are associated with performance differentials among high Medicaid nursing homes. Higher financial performing facilities are characterized as having nurse practitioners/physician assistants, more beds, higher occupancy rate, higher Medicare and Medicaid census, and being for-profit and located in less competitive markets. Higher levels of Registered Nurse (RN) skill mix result in lower financial performance in high Medicaid nursing homes. Policy and managerial implications of the study are discussed.
高医疗补助养老院（医疗补助居民占比达85%及以上）在资源受限的环境中运营。高医疗补助养老院（平均而言）质量较低且财务表现较差。然而，高医疗补助养老院之间的表现存在显著差异。本研究的目的是考察可能与高医疗补助养老院更好的财务表现相关的组织和市场因素。数据来源包括长期护理聚焦（LTCFocus）、医疗保险和医疗补助服务中心（CMS）的医疗保险成本报告、CMS养老院比较以及2009 - 2015年的地区卫生资源文件（AHRF）。每年约有1108家高医疗补助设施。因变量是养老院运营利润率和总利润率。自变量包括规模、连锁关系、入住率、医疗保险占比、市场竞争以及县社会经济状况。控制变量包括人员配备变量、居民质量、营利性状态、 acuity指数、设施内少数族裔占比、医疗补助居民占比、大都市区以及医疗保险优势渗透率。使用带有州和年份固定效应的广义估计方程对数据进行分析。结果表明，组织和市场闲置资源与高医疗补助养老院之间的绩效差异相关。财务表现较好的设施的特点是拥有执业护士/医师助理、更多床位、更高入住率、更高的医疗保险和医疗补助人口普查数、为营利性且位于竞争较小的市场。在高医疗补助养老院中，较高水平的注册护士（RN）技能组合会导致较低的财务表现。讨论了该研究的政策和管理意义。
