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CFPHD Guest Speaker Dr. Chisholm: Nursing Home Quality and Financial Performance
 

CFPHD Guest Speaker Dr. Chisholm: Nursing Home Quality and Financial Performance

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Conversation on Nursing Home Quality, Health Disparities in Central Florida ...

Conversation on Nursing Home Quality, Health Disparities in Central Florida
Health Professionals Discuss the Facts and Future for Aging, Poor Central Floridians

The Central Florida Partnership on Health Disparities invited members and guests to join the conversation with University of Central Florida assistant professor Dr. Latarsha Chisholm as we discussed her recent publication within the Health Services Research journal – Nursing Home Quality and Financial Performance: Does the Racial Composition of Residents Matter? This event was held at Anthem College, Tuesday, October 22, 2013, from 3:00 to 5:00pm.

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    CFPHD Guest Speaker Dr. Chisholm: Nursing Home Quality and Financial Performance CFPHD Guest Speaker Dr. Chisholm: Nursing Home Quality and Financial Performance Presentation Transcript

    • Nursing Home Quality and Financial Performance: Does the Racial Composition of Residents Matter? Latarsha Chisholm, PhD Assistant Professor Department of Health Management & Informatics
    • Acknowledgement • • • • Robert Weech-Maldonado, PhD Alex Laberge, PhD Feng-Chang Lin, PhD Kathryn Hyer, PhD
    • Background • • • 1. 2. Nursing homes – Approximately 15,500 NHs in 2011 1 Nursing home residents – An estimated 1.4 million residents 1 Payers of long-term care 2 – Medicaid and Medicare (post-acute care) • Paid for ~60% of long-term care (LTC )services – Out-of-pocket • Paid for ~15% of LTC services – Long-term care insurance • Paid for ~7% of LTC services – Other • Paid for ~17% of LTC services Kaiser commission on Medicaid and Uninsured analysis of 2011 Online Survey, Certification, and Reporting system (OSCAR) data Kaiser commission on Medicaid and the Uninsured. (2013). Medicaid’s role in meeting the long-term care needs of America’s Seniors. Retrieved from: http://kaiserfamilyfoundation.files.wordpress.com/2013/02/8403.pdf
    • Quality of Nursing Home Care • Nursing home quality has been a longstanding public policy issue 1,2 1. 2. Institute of Medicine. (1986). Improving the quality of care in nursing homes. Washington, D.C: National Academy Press. Institute of Medicine. (2001). Improving the quality of long-term care. Washington, D.C. National Academy Press
    • Racial/Ethnic Disparities in Quality of Care • Prior research indicates racial/ethnic disparities are present in nursing homes: – Black residents have a higher prevalence of pressure ulcers1 – Black residents are less likely to receive a flu vaccination2 – Black residents are more likely to have feeding tubes3 – Black residents have a higher rate of hospitalization4 1. 2. 3. 4. Cai, S., Mukamel, D., & Temkin-Greener, H. (2010). Pressure ulcer prevalence among Black and White nursing home residents in New York state: Evidence of racial disparity? Medical Care, 48, 3. Cai, S., et al., (2011). Despite small improvement Black nursing home residents remain less likely than Whites to receive flu vaccine. Health Affairs, 30, 10. Grabowksi, D., & McGuire, T. (2009). Black-White disparities in care in nursing homes. Atlantic Economic Journal, 37. Gruneir, A. et al., (2008). Relationship between state Medicaid policies, nursing home racial composition, and the risk of hospitalization for Black and White residents. Health Services Research, 43, 3.
    • Possible Contributors of Disparities • Nursing home segregation – Residential segregation – Admission policies • Medicaid-reliant nursing homes1 – Lower quality of care – Fewer nursing staff 1. Mor, V., et al., (2004). Driven to tiers: Socioeconomic and racial disparities in the quality of nursing home care. Milbank Quarterly, 82, 2.
    • Significance • Growth in the minority population – Between 2010 and 2050 the minority population age 65 and older is expected to increase from 20% to 42% of the total population age 65 and older1 • Nursing home use – Recent studies indicate increase use of nursing homes among minorities2 1. 2. U.S. Census Bureau. (2008). An older and diverse nation by midcentury. Available at http://www.census.gov/newsroom/releases/archives/population/cb08-123.html Feng et al., (2011). Growth of racial and ethnic minorities in nursing homes driven by demographics and possible disparities in options. Health Affairs, 30, 7.
    • Research Purpose • Examine the relationship between the racial composition of nursing home residents and nursing home financial performance • Examine whether financial performance influenced the relationship the racial composition of residents and the quality of care in nursing homes
    • Methods • • Data – On-Line Survey Certification and Reporting (OSCAR) • Information on facility structure – Medicare Cost Report • Information on revenues and expenses – Minimum Data Set (MDS) • Information on residents – Area Resource File (ARF) • Information on census, health and social resources Sample – Medicare and Medicaid nursing homes in the US between the years of 1999-2004
    • RESULTS: Racial Composition of NH Residents and Financial Performance • Nursing homes with no black residents exhibited better financial and quality outcomes – Relative to NHs with high proportions of black residents, NHs with no black residents had higher total profit margins, higher operating margins, higher operating revenue per patient day (PPD), higher other revenue per patient day, and lower percent of Medicaid residents – NHs with no and medium proportions of Black residents had fewer quality of care deficiencies and fewer actual harm citations than nursing homes
    • RESULTS: Financial performance influenced the relationship the racial composition of residents and the quality • Financial performance measures do partially influence the relationship between racial composition of residents and quality of care
    • Policy Recommendations • Increase Medicaid payment to nursing homes with high proportions of minority residents • Implement pay-for-performance • Environmental trends – Reduced residential segregation – Lower occupancy rates
    • Thank You