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| 001 | 0060116443437 | ||
| 003 | OSt | ||
| 005 | 20190211172308.0 | ||
| 008 | 100601s1997 xx ||||gr |0|| 0 eng d | ||
| 100 | 1 |
_aBROYLES, Robert _940778 |
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| 245 | 1 | 0 |
_aCase-mix nursing home reimbursement : _ba technical fix for a policy inadequacy? |
| 260 |
_aNew York : _bMarcel Dekker, _c1997 |
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| 520 | 3 | _aMost state Medicaid programs, in many cases the largest fundors of long term care, reimburse nursing homes or home health agencies on negotiated flat rates. However, several states have implemented or are planning to use reimbursement methods using case-mix indices to adjust for the different variable costs (e.g., resource utilization groups, RUGs) incurred in caring for different types of patients. Advocates contend that such methods can simultaneously help contain costs and enhance access by motivating the nursing home to keep costs below predetermined rates and mitigating providers' reluctance to admit heavy care residents. The numbers of such residents putatively have increased as a result of incentives in the Prospective Payment System for hospitals to more quickly discharge sicker patients. However, the potentially negative effects of case-mix reimbursement (CMR) on quality of care have not gone unnoticed, and the costs (as yet undetermined) of mechanisms to avert these effects likely are nontrivial. | |
| 520 | 3 | _aThis paper examines the effects of CMR on cost (to states and nursing homes), access and quality. A preliminary review of the available evidence seems to indicate mixed results; yet, CMR obviously appeals to some Medicaid programs and representatives of the nursing home industry. We suggest that the allure of CMR may be due to a mistaken belief that, to borrow from Brandon (1990), such tech fixes obviate irksome negotiation on the part of policy elites. | |
| 520 | 3 | _aAn alternate reimbursement policy is proposed: a negotiated prepayment, based on a facility's global budget, with periodic allocations and an end of period adjustment to compensate the provider for unanticipated costs. | |
| 700 | 1 |
_aFALCONE, David _940779 |
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| 773 | 0 | 8 |
_tInternational Journal of Public Administration - IJPA _g20, 2, p. 339-377 _dNew York : Marcel Dekker, 1997 _xISSN 01900692 _w |
| 942 | _cS | ||
| 998 |
_a20100601 _b1644^b _cDaiane |
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| 998 |
_a20100604 _b1533^b _cCarolina |
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_aConvertido do Formato PHL _bPHL2MARC21 1.1 _c33851 _d33851 |
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| 041 | _aeng | ||